Adhesion development and morbidity after repeat cesarean delivery.

OBJECTIVE:

The purpose of this study was to evaluate the development and implications of intraabdominal adhesions after repeat cesarean section delivery (CS).

STUDY DESIGN:

We reviewed the charts of 1283 women who underwent repeat CS and 203 other women who underwent primary CS. Primary outcome measures were incidence and extent of adhesions, incision-to-delivery interval, and operating time.

RESULTS:

No adhesions were found in primary CS. Compared with those women with a second CS (24.4%), significantly more women had adhesions after 3 CSs (42.8%; 95% confidence interval [CI], 0.84-0.99). Compared with a first CS (7.7 +/- 0.3 minutes), the delivery time was significantly longer at subsequent CSs (second CS, 9.4 +/- 0.1 minutes; 95% CI, 1-2; third CS, 10.6 +/- 0.3 minutes; 95% CI, 2-4; >or= 4 CSs, 10.4 +/- 0.1 minutes; 95% CI, 1-2). However, complication rates in those women with >or= 2 CSs were comparable with primary CS.

CONCLUSION:

Increased adhesion development and a longer time to delivery were found with each subsequent CS.