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Abdominal adhesions in gynaecologic surgery after caesarean section: a longitudinal population‐based register study
Author(s) -
Hesselman S,
Högberg U,
Råssjö EB,
Schytt E,
Löfgren M,
Jonsson M
Publication year - 2018
Publication title -
bjog: an international journal of obstetrics and gynaecology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.157
H-Index - 164
eISSN - 1471-0528
pISSN - 1470-0328
DOI - 10.1111/1471-0528.14708
Subject(s) - medicine , caesarean section , odds ratio , obstetrics , body mass index , population , pregnancy , abdominal surgery , adhesion , confidence interval , gynecology , hysterectomy , incidence (geometry) , surgery , chemistry , genetics , physics , environmental health , organic chemistry , optics , biology
Objective The aim of the study was to evaluate the association between abdominal adhesions at the time of gynaecologic surgery and a history of caesarean delivery, and to investigate obstetric factors contributing to adhesion formation after caesarean section ( CS ). Design Longitudinal population‐based register study. Setting Sweden. Population Women undergoing benign hysterectomy and/or adnexal surgery in Sweden, 2000–2014, with a previous delivery during 1973–2013 ( n = 15 479). Methods Information about abdominal adhesions during gynaecological surgery, prior medical history, pregnancies and deliveries were retrieved from Swedish National Health and Quality registers. Main outcome measures Adhesions. Results In women with previous CS , adhesions were present in 37%, compared with 10% of women with no previous CS [odds ratio ( OR ): 5.18, 95% confidence interval ( CI ): 4.70–5.71]. Adhesions increased with the number of caesarean sections: 32% after one CS ; 42% after two CS and 59% after three or more CS ( P < 0.001). Regardless of the number of CS , factors at CS such as age ≥35 years ( aOR : 1.28, 95% CI : 1.05–1.55), body mass index ( BMI ) ≥30 [adjusted OR ( aOR ): 1.91, 95% CI : 1.49–2.45] and postpartum infection ( aOR : 1.55, 95% CI : 1.05–2.30) increased the risk of adhesions. Conclusions Presence of adhesions in abdominal gynaecological surgery is associated with women's personal history of caesarean delivery. The number of caesarean sections was the important predictor of adhesions; advanced age, obesity and postpartum infection further increased the incidence. Tweetable abstract Repeat caesarean, age, obesity and infection increased the risk of pelvic adhesions after caesarean section.