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Prevalence of pelvic adhesions on ultrasound examination in women with a history of Cesarean section
Author(s) -
Moro F.,
Mavrelos D.,
Pateman K.,
Holland T.,
Hoo W. L.,
Jurkovic D.
Publication year - 2015
Publication title -
ultrasound in obstetrics and gynecology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 3.202
H-Index - 141
eISSN - 1469-0705
pISSN - 0960-7692
DOI - 10.1002/uog.14628
Subject(s) - medicine , pelvic pain , pelvic examination , odds ratio , pelvis , physical examination , adhesion , ultrasound , medical history , surgery , obstetrics , radiology , chemistry , organic chemistry
Objectives To investigate the prevalence and location of pelvic adhesions in women with a history of Cesarean section and to identify risk factors for their formation and symptoms associated with their presence. Methods This was a prospective observational study of women in whom one or more Cesarean sections had been performed > 12 months previously and who attended for a gynecological ultrasound examination. In all women, both transvaginal and transabdominal scans were performed in order to identify the presence of pelvic adhesions. Medical and surgical history was recorded and a structured questionnaire was used to enquire about any history of pelvic pain and urinary symptoms. Results A total of 308 women were recruited into the study. On ultrasound examination, 139 (45.1% (95% CI , 39.7–50.7%)) women showed evidence of adhesions within the pelvis. Adhesions in the vesicouterine pouch were the most common and were found in a total of 79 (25.6% (95% CI , 20.7–30.5%)) women. In women with a history of no surgery other than Cesarean section(s) ( n = 220), an increasing number of Cesarean sections (odds ratio ( OR ) 3.4 (95% CI , 2.1–5.5)) and a postoperative wound infection ( OR 11.7 (95% CI , 3.5–39.5)) increased the likelihood of adhesions developing in the anterior pelvic compartment. There was a significant association between the presence of anterior compartment adhesions and chronic pelvic pain. Multivariable logistic regression analysis identified anterior abdominal wall adhesions ( OR 2.4 (95% CI , 1.0–5.9)) and any adhesions present on ultrasound scan ( OR 2.6 (95% CI , 1.2–5.7)) as independent predictors of chronic pelvic pain. Conclusions Pelvic adhesions are present in more than a third of women with a history of Cesarean section and they are associated with chronic pelvic pain. Copyright © 2014 ISUOG. Published by John Wiley & Sons Ltd.