title: Incidence of adhesions and maternal and neonatal morbidity after repeat cesarean section.
abstract: OBJECTIVE
  We investigated the effect of repeat cesarean sections (CSs) and intra-abdominal adhesions on neonatal and maternal morbidity.
  
  
  METHODS
  We analyzed intra-abdominal adhesions of 672 patients.
  
  
  RESULTS
  Among the patients, 173, 206, 151, and 142 underwent CS for the first, second, third, and fourth time or more, respectively. There were adhesions in 393 (58.5 %) patients. Among first CSs, there were no adhesions, the rate of maternal morbidity [Morales et al. (Am J Obstet Gynecol 196(5):461, 2007)] was 26 %, and the rate of neonatal morbidity (NM) was 35 %. Among women who have history of two CSs, the adhesion rate was 66.3 %, the adhesion score was 2.05, MM was 14 %, and NM was 21 %. Among third CSs, these values were 82.1, 2.82, 23, and 14 %, respectively. Among women who have history of four or more CSs, these values were 92.2, 4.72, 31.7, and 18 %, respectively. Adhesion sites and dense fibrous adhesions increased parallel to the number of subsequent CSs. Increased adhesion score was associated with 1.175-fold higher odds of NM and 1.29-fold higher odds of MM. The rate of NM was eightfold higher in emergency-delivered newborns (emergency: 39.4, 40 %; elective: 4.9 %). MM was 20 and 26 % for elective and emergency CSs, respectively.
  
  
  CONCLUSIONS
  Emergency operations and adhesions increased complications.
authors: Department of Obstetrics and Gynecology, Adana Numune Training and Research Hospital, Adana, Turkey. sefaarlier@gmail.com.
authors: Sefa
authors: http://orcid.org/0000-0002-0019-8403
authors: S
authors: Arlier
authors: Department of Obstetrics and Gynecology, Adana Numune Training and Research Hospital, Adana, Turkey.
authors: Sevtap
authors: S
authors: Seyfettinoğlu
authors: Department of Obstetrics and Gynecology, Adana Numune Training and Research Hospital, Adana, Turkey.
authors: EsraSaygili
authors: E
authors: Yilmaz
authors: Department of Obstetrics and Gynecology, Adana Numune Training and Research Hospital, Adana, Turkey.
authors: Hakan
authors: H
authors: Nazik
authors: Department of Obstetrics and Gynecology, Adana Numune Training and Research Hospital, Adana, Turkey.
authors: Cevdet
authors: C
authors: Adıgüzel
authors: Department of Obstetrics and Gynecology, Harran University, Sanliurfa, Turkey.
authors: Eda
authors: E
authors: Eskimez
authors: Department of Obstetrics and Gynecology, Adana Numune Training and Research Hospital, Adana, Turkey.
authors: Şerif
authors: Ş
authors: Hürriyetoğlu
authors: Department of Obstetrics and Gynecology, Adana Numune Training and Research Hospital, Adana, Turkey.
authors: Oğuz
authors: O
authors: Yücel
mesh_terms: D000328:Adult; D002585:Cesarean Section / Q000009:adverse effects*; D017604:Cesarean Section, Repeat / Q000009:adverse effects*; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D015994:Incidence; D007223:Infant; D007226:Infant Mortality / Q000639:trends*; D007231:Infant, Newborn; D011247:Pregnancy; D011446:Prospective Studies; D000267:Tissue Adhesions / Q000209:etiology* / Q000473:pathology
keywords: Intraoperative complication; Morbidity; Postoperative complication; Repeat cesarean section; Tissue adhesion