title: Cesarean wound scar characteristics for the prediction of pelvic adhesions: a meta-analysis of observational studies.
abstract: OBJECTIVE
  The pathophysiologic processes that result in wound healing are the same regardless of the tissue involved. The purpose of the present meta-analysis is to evaluate whether cesarean scar characteristics may predict the presence of pelvic adhesions.
  
  
  METHODS
  We conducted a systematic review searching the Medline (1966-2016), Scopus (2004-2016), ClinicalTrials.gov (2008-2016), Cochrane Central Register of Controlled Trials CENTRAL (1999-2016) and Google Scholar (2004-2016) databases together with reference lists from included studies. All prospective and retrospective observational cohort studies were included. Statistical meta-analysis was performed using the RevMan 5.1 software.
  
  
  RESULTS
  Current evidence suggests that depressed scars are positively associated with intra-abdominal adhesions (ΟR 2.79, 95%CI 1.74-4.46). Elevated scars might also correlate with the presence of adhesions, however, this association did not reach statistical significance (OR 1.61, 95%CI 0.91-2.85, p = 0.10). The same was reported in the case of scar pigmentation (REM, OR 1.68, 95%CI 0.86-3.26, p = 0.13). Flat scars were predictive of the absence of adhesions (899 patients, REM, OR 0.33, 95%CI 0.23-0.54, p < 0.00001).
  
  
  CONCLUSIONS
  According to our meta-analysis, abdominal wound characteristics following cesarean section can predict the presence of adhesions. However, given the small number of published studies, further research is needed to corroborate our findings.
authors.affiliation: a Laboratory of Experimental Surgery and Surgical Research N.S. Christeas , National and Kapodistrian University of Athens , Athens , Greece and.
authors.forename: Vasilios
authors.initials: V
authors.lastname: Pergialiotis
authors.affiliation: a Laboratory of Experimental Surgery and Surgical Research N.S. Christeas , National and Kapodistrian University of Athens , Athens , Greece and.
authors.forename: Maximos
authors.initials: M
authors.lastname: Frountzas
authors.affiliation: a Laboratory of Experimental Surgery and Surgical Research N.S. Christeas , National and Kapodistrian University of Athens , Athens , Greece and.
authors.forename: Charalampos
authors.initials: C
authors.lastname: Siotos
authors.affiliation: a Laboratory of Experimental Surgery and Surgical Research N.S. Christeas , National and Kapodistrian University of Athens , Athens , Greece and.
authors.forename: Nikoleta
authors.initials: N
authors.lastname: Karampetsou
authors.affiliation: a Laboratory of Experimental Surgery and Surgical Research N.S. Christeas , National and Kapodistrian University of Athens , Athens , Greece and.
authors.forename: Despina N
authors.initials: DN
authors.lastname: Perrea
authors.affiliation: b 1st Department of Obstetrics and Gynecology, Alexandra University Hospital, National and Kapodistrian University of Athens , Athens , Greece.
authors.forename: Dimitrios
authors.initials: D
authors.lastname: Efthymios Vlachos
mesh_terms: D002585:Cesarean Section; D002921:Cicatrix / Q000473:pathology*; D005260:Female; D006801:Humans; D064887:Observational Studies as Topic; D011247:Pregnancy; D011446:Prospective Studies; D012189:Retrospective Studies; D000267:Tissue Adhesions / Q000175:diagnosis*; D014945:Wound Healing / Q000502:physiology*
keywords: Adhesions; cesarean section; pelvic; wound scar