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Nunes I, Nicholson W, Theron G. FIGO good practice recommendations on surgical techniques to improve safety and reduce complications during cesarean delivery. Int J Gynaecol Obstet 2023; 163 Suppl 2:21-33. [PMID: 37807585 DOI: 10.1002/ijgo.15117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/10/2023]
Abstract
FIGO is actively contributing to the global effort to reduce maternal morbidity, mortality, and disability worldwide. Cesarean delivery rates are increasing globally, without signs of slowing down. Bleeding associated with cesarean delivery has become an important cause of hemorrhage-related maternal deaths in many low- and middle-income countries. Correct surgical techniques to improve safety and reduce complications of cesarean delivery is of the utmost importance. This article presents FIGO's good practice recommendations for effective surgical techniques to reduce cesarean complications. Evidence-based information is included where data are available. An expanded WHO Surgical Safety Checklist for maternity cases is suggested. Different incision techniques through the layers of the abdominal wall with appropriate indications are discussed. Hysterotomy through a transverse incision is described, as are indications for low vertical and classical incisions. Important precautions when extracting the fetus are explained. Uterine closure includes a safe method ensuring adequate reapproximation of the upper segment if a vertical incision is made. The paper concludes with the management of two common bleeding problems following delivery of the placenta.
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Affiliation(s)
- Inês Nunes
- Centro Hospitalar Vila Nova de Gaia/Espinho, Department of Obstetrics and Gynaecology, CINTESIS - Center for Health Technology and Services Research, University of Porto, Porto, Portugal
| | - Wanda Nicholson
- George Washington University Milken School of Public Health, Washington, District of Columbia, USA
| | - Gerhard Theron
- Department of Obstetrics and Gynecology, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
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Dawood AS, Elgergawy AE. Incidence and sites of pelvic adhesions in women with post-caesarean infertility. J OBSTET GYNAECOL 2018; 38:1158-1163. [PMID: 29882442 DOI: 10.1080/01443615.2018.1460583] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
This cross-sectional study was designed to evaluate the incidences and sites of pelvic adhesions in women with post-caesarean unexplained infertility. This study was conducted at the Tanta University Hospitals in the period from August 1 2015 to July 31 2016. The enrolled patients were assessed by a diagnostic laparoscopy for the presence and sites of abdominal and pelvic adhesions. Pelvic adhesions were found in 98 cases (73.13%) and the remaining 36 cases (26.87%) were free of adhesions. Adhesions were tubal in 55.10%, ovarian in 20.40%, combined tubo-ovarian and omental adhesions in 11.22%, uterine adhesions in 6.12% and a frozen pelvis was found in 7.14%. There was no correlation between the severity of the adhesions and the number of previous caesarean sections (CS). The data of this study led us to conclude that pelvic adhesions are common in patients with unexplained infertility following a caesarean delivery. Tubal and ovarian adhesions to the lateral pelvic wall represent a pathognomonic feature in post-caesarean infertility. Impact Statement What is already known on this subject? Adhesions following a caesarean delivery have been assessed by many studies at the time of the next caesarean delivery. These adhesions have not been studied well in the patients with unexplained infertility. What the results of this study add? The results of this study specify the incidences and the sites of the adhesions which are considered to be pathognomonic for caesarean section. What the implications are of these findings for clinical practice and/or further research? These findings should be applied when the cases of post-caesarean infertility are evaluated in order to shorten the duration and burdens of infertility.
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Affiliation(s)
- Ayman Shehata Dawood
- a Department of Obstetrics and Gynecology, Faculty of Medicine , Tanta University , Tanta , Egypt
| | - Adel Elshahat Elgergawy
- a Department of Obstetrics and Gynecology, Faculty of Medicine , Tanta University , Tanta , Egypt
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3
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Alamo L, Vial Y, Denys A, Andreisek G, Meuwly JY, Schmidt S. MRI findings of complications related to previous uterine scars. Eur J Radiol Open 2018; 5:6-15. [PMID: 29387735 PMCID: PMC5790820 DOI: 10.1016/j.ejro.2018.01.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2017] [Revised: 12/28/2017] [Accepted: 01/04/2018] [Indexed: 01/23/2023] Open
Abstract
Although the World Health Organization suggests 10–15% as the adequate cesarean delivery rate to assure optimal prognosis for mother and children, cesarean rates have continuously increased worldwide over the last three decades, even in primiparous women. Moreover, uterine scars after myomectomies, complications of obstetrical interventions and more recently, after fetal surgery, are often observed. This review article describes the most commonly seen complications related to prior uterine scars and discusses their imaging findings, with emphasis on the increasing role of Magnetic Resonance Imaging for diagnosis.
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Affiliation(s)
- Leonor Alamo
- Department of Diagnostic and Interventional Radiology, University Hospital of Lausanne (CHUV) and University of Lausanne (UNIL) Rue du Bugnon, 46, 1011, Lausanne, Switzerland
| | - Yvan Vial
- Department of Gynecology and Obstetrics, University Hospital of Lausanne (CHUV) and University of Lausanne (UNIL), Rue du Bugnon, 46, 1011, Lausanne, Switzerland
| | - Alban Denys
- Department of Diagnostic and Interventional Radiology, University Hospital of Lausanne (CHUV) and University of Lausanne (UNIL) Rue du Bugnon, 46, 1011, Lausanne, Switzerland
| | - Gustav Andreisek
- Department of Diagnostic Radiology, Institute of Diagnostic and interventional Radiology, University Hospital of Zurich and University of Zurich, Ramistrasse 100, 8091, Zurich, Switzerland
| | - Jean-Yves Meuwly
- Department of Diagnostic and Interventional Radiology, University Hospital of Lausanne (CHUV) and University of Lausanne (UNIL) Rue du Bugnon, 46, 1011, Lausanne, Switzerland
| | - Sabine Schmidt
- Department of Diagnostic and Interventional Radiology, University Hospital of Lausanne (CHUV) and University of Lausanne (UNIL) Rue du Bugnon, 46, 1011, Lausanne, Switzerland
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4
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Arlier S, Seyfettinoğlu S, Yilmaz E, Nazik H, Adıgüzel C, Eskimez E, Hürriyetoğlu Ş, Yücel O. Incidence of adhesions and maternal and neonatal morbidity after repeat cesarean section. Arch Gynecol Obstet 2016; 295:303-311. [PMID: 27770246 DOI: 10.1007/s00404-016-4221-8] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2016] [Accepted: 10/14/2016] [Indexed: 11/30/2022]
Abstract
PURPOSE OF INVESTIGATION We investigated the effect of repeat cesarean sections (CSs) and intra-abdominal adhesions on neonatal and maternal morbidity. MATERIALS AND 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.
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Affiliation(s)
- Sefa Arlier
- Department of Obstetrics and Gynecology, Adana Numune Training and Research Hospital, Adana, Turkey.
| | - Sevtap Seyfettinoğlu
- Department of Obstetrics and Gynecology, Adana Numune Training and Research Hospital, Adana, Turkey
| | - EsraSaygili Yilmaz
- Department of Obstetrics and Gynecology, Adana Numune Training and Research Hospital, Adana, Turkey
| | - Hakan Nazik
- Department of Obstetrics and Gynecology, Adana Numune Training and Research Hospital, Adana, Turkey
| | - Cevdet Adıgüzel
- Department of Obstetrics and Gynecology, Adana Numune Training and Research Hospital, Adana, Turkey
| | - Eda Eskimez
- Department of Obstetrics and Gynecology, Harran University, Sanliurfa, Turkey
| | - Şerif Hürriyetoğlu
- Department of Obstetrics and Gynecology, Adana Numune Training and Research Hospital, Adana, Turkey
| | - Oğuz Yücel
- Department of Obstetrics and Gynecology, Adana Numune Training and Research Hospital, Adana, Turkey
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5
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Lyell DJ, Power M, Murtough K, Ness A, Anderson B, Erickson K, Schulkin J. Surgical Techniques at Cesarean Delivery: A U.S. Survey. Surg J (N Y) 2016; 2:e119-e125. [PMID: 28825004 PMCID: PMC5553495 DOI: 10.1055/s-0036-1594247] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2016] [Accepted: 10/13/2016] [Indexed: 02/02/2023] Open
Abstract
Objective To assess the frequency of surgical techniques at cesarean delivery (CD) among U.S. obstetricians. Methods Members of the American College of Obstetrician Gynecologists were randomly selected and e-mailed an online survey that assessed surgical closure techniques, demographics, and reasons. Data were analyzed using SPSS (IBM Corp., Armonk, New York, United States), descriptive statistics, and analysis of variance. Results Our response rate was 53%, and 247 surveys were analyzed. A similar number of respondents either "always or usually" versus "rarely or never" reapproximate the rectus muscles (38.4% versus 43.3%, p = 0.39), and close parietal peritoneum (42.5% versus 46.9%, p = 0.46). The most frequently used techniques were double-layer hysterotomy closure among women planning future children (73.3%) and suturing versus stapling skin (67.6%); the least frequent technique was closure of visceral peritoneum (12.2%). Surgeons who perform double-layer hysterotomy closure had fewer years in practice (15.0 versus 18.7 years, p = 0.021); surgeons who close visceral peritoneum were older (55.5 versus 46.4 years old, p < 0.001) and had more years in practice (23.8 versus 13.8 years practice; p < 0.001). Conclusion Similar numbers of obstetricians either reapproximate or leave open the rectus muscles and parietal peritoneum at CD, suggesting that wide variation in practice exists. Surgeon demographics and safety concerns play a role in some techniques.
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Affiliation(s)
- Deirdre J. Lyell
- Department of Obstetrics and Gynecology, Stanford University, Palo Alto, California
| | - Michael Power
- Research Department, American College of Obstetricians & Gynecologists, Washington, District of Columbia
| | - Katie Murtough
- Research Department, American College of Obstetricians & Gynecologists, Washington, District of Columbia
| | - Amen Ness
- Department of Obstetrics and Gynecology, Stanford University, Palo Alto, California
| | - Britta Anderson
- Research Department, American College of Obstetricians & Gynecologists, Washington, District of Columbia
| | - Kristine Erickson
- Research Department, American College of Obstetricians & Gynecologists, Washington, District of Columbia
| | - Jay Schulkin
- Research Department, American College of Obstetricians & Gynecologists, Washington, District of Columbia
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6
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Bolnick A, Bolnick J, Diamond MP. Postoperative Adhesions as a Consequence of Pelvic Surgery. J Minim Invasive Gynecol 2015; 22:549-63. [DOI: 10.1016/j.jmig.2014.12.009] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2014] [Revised: 12/05/2014] [Accepted: 12/08/2014] [Indexed: 01/12/2023]
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7
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Adhesions at repeat cesarean delivery: is there a personal impact? Arch Gynecol Obstet 2015; 292:813-8. [DOI: 10.1007/s00404-015-3718-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2014] [Accepted: 04/07/2015] [Indexed: 11/27/2022]
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8
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Park SY, Lee JH, Choi JS, Bae J, Lee WM, Ko JH, Koh AR, Park SH. Laparoscopically assisted vaginal hysterectomy for women with anterior wall adherence after cesarean section. JSLS 2014; 18:JSLS-D-13-00315. [PMID: 25392638 PMCID: PMC4154428 DOI: 10.4293/jsls.2014.00315] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Objectives: To share and report experiences of using lateral approach technique to perform laparoscopically assisted vaginal hysterectomy (LAVH) for women with anterior wall adherence after cesarean section. Methods: We analyzed a retrospective chart review of 47 women with anterior wall adhesion after a cesarean section who underwent LAVH from March 1st 2003 to March 31st 2012, selected from a total of 1967 women who underwent LAVH during that period. Results: The median age of the patients was 42 years (range 34–56 years). The median operating time was 120 minutes (range 85–240 minutes), and the median weight of the removed uterus was 247 g (range 50–896 g). The median change in hemoglobin level was 2.0 g/dL (range 0–3.0 g/dL). The median hospital stay was 3.0 days (range 2–6 days). There were complications in 2 cases: bladder injury in one and postoperative ileus in the other. There were no conversions to laparotomy. Conclusions: Lateral approach technique to make a pneumoperitoneum and to perform adhesiolysis is effective in LAVH for women with anterior wall adherence after cesarean section.
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Affiliation(s)
- Sue Yeon Park
- Department of Obstetrics and Gynecology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Jung Hun Lee
- Department of Obstetrics and Gynecology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Joong Sub Choi
- Department of Obstetrics and Gynecology, Hanyang University College of Medicine, Seoul, Republic of Korea
| | - Jaeman Bae
- Department of Obstetrics and Gynecology, Hanyang University College of Medicine, Seoul, Republic of Korea
| | - Won Moo Lee
- Department of Obstetrics and Gynecology, Hanyang University College of Medicine, Seoul, Republic of Korea
| | - Jung Hwa Ko
- Department of Obstetrics and Gynecology, Hanyang University College of Medicine, Seoul, Republic of Korea
| | - A Ra Koh
- Department of Obstetrics and Gynecology, Hanyang University College of Medicine, Seoul, Republic of Korea
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9
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Impact of single- vs double-layer closure on adverse outcomes and uterine scar defect: a systematic review and metaanalysis. Am J Obstet Gynecol 2014; 211:453-60. [PMID: 24912096 DOI: 10.1016/j.ajog.2014.06.014] [Citation(s) in RCA: 56] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2014] [Revised: 05/28/2014] [Accepted: 06/05/2014] [Indexed: 02/07/2023]
Abstract
A systematic review and metaanalysis were performed through electronic database searches to estimate the effect of uterine closure at cesarean on the risk of adverse maternal outcome and on uterine scar evaluated by ultrasound. Randomized controlled trials, which compared single vs double layers and locking vs unlocking sutures for uterine closure of low transverse cesarean, were included. Outcomes were short-term complications (endometritis, wound infection, maternal infectious morbidity, blood transfusion, duration of surgical procedure, length of hospital stay, mean blood loss), uterine rupture or dehiscence at next pregnancy, and uterine scar evaluation by ultrasound. Twenty of 1278 citations were included in the analysis. We found that all types of closure were comparable for short-term maternal outcomes, except for single-layer closure, which had shorter operative time (-6.1 minutes; 95% confidence interval [CI], -8.7 to -3.4; P < .001) than double-layer closure. Single layer (-2.6 mm; 95% CI, -3.1 to -2.1; P < .001) and locked first layer (mean difference, -2.5 mm; 95% CI, -3.2 to -1.8; P < .001) were associated with lower residual myometrial thickness. Two studies reported no significant difference between single- vs double-layer closure for uterine dehiscence (relative risk, 1.86; 95% CI, 0.44-7.90; P = .40) or uterine rupture (no case). In conclusion, current evidence based on randomized trials does not support a specific type of uterine closure for optimal maternal outcomes and is insufficient to conclude about the risk of uterine rupture. Single-layer closure and locked first layer are possibly coupled with thinner residual myometrium thickness.
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10
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Adhesion prevention after cesarean delivery: evidence, and lack of it. Am J Obstet Gynecol 2014; 211:446-52. [PMID: 24858198 DOI: 10.1016/j.ajog.2014.05.027] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2014] [Accepted: 05/20/2014] [Indexed: 11/21/2022]
Abstract
In spite of the recognized occurrence of cesarean-attributable adhesions, its clinical significance is uncertain. The presence of adhesions during a repeat cesarean section can make fetal extraction lengthy and the procedure challenging and may increase the risk of injury to adjacent organs. Two methods for adhesion prevention are discussed, peritoneal closure and use of adhesion barriers. Peritoneal closure appears to be safe in the short term. In the long term, conflicting evidence arise from reviewing the literature for possible adhesion reduction benefits. A systematic review of the literature on the use of adhesion barriers in the context of cesarean section yielded only a few studies, most of which are lacking in methodology. For now, it appears that the available evidence does not support the routine use of adhesion barriers during cesarean delivery.
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11
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Poole JH. Adhesions following cesarean delivery: a review of their occurrence, consequences and preventative management using adhesion barriers. ACTA ACUST UNITED AC 2014; 9:467-77. [PMID: 24007252 DOI: 10.2217/whe.13.45] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
The objective of this article is to provide a comprehensive review of the occurrence and consequences of postoperative adhesions following cesarean delivery (CD), and an overview of the published clinical data on prevention in this setting using adhesion barriers. Adhesions occur frequently after CD and the incidence increases with each subsequent CD. Repeat CDs are complicated by adhesions, which increase operating time, time to delivery and risk of bladder injury. Clinical data on the efficacy of adhesion prevention strategies specific to the setting of CD are limited. Two small, nonrandomized studies found that the use of absorbable anti-adhesion barriers was associated with a significant reduction in adhesion formation and a shorter time to delivery at repeat CD, compared with no barrier use. Implications for practice and research are discussed. There is a significant need for well-controlled, randomized clinical studies investigating adhesion prevention in the labor and delivery setting.
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Affiliation(s)
- Judith H Poole
- Queens University of Charlotte, Blair College of Health, Presbyterian School of Nursing, 1900 Selwyn Avenue, Charlotte, NC 28274, USA.
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12
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Adhesions after abdominal surgery: a systematic review of the incidence, distribution and severity. Surg Today 2013; 44:405-20. [PMID: 23657643 DOI: 10.1007/s00595-013-0591-8] [Citation(s) in RCA: 141] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2012] [Accepted: 02/07/2013] [Indexed: 12/20/2022]
Abstract
Abdominal adhesions are associated with increased postoperative complications, cost and workload. We performed a systematic review with statistical pooling to estimate the formation rate, distribution and severity of postoperative adhesions in patients undergoing abdominal surgery. A literature search was carried out for all articles reporting on the incidence, distribution and severity of adhesions between January 1990 and July 2011. Twenty-five articles fulfilled the inclusion criteria. The weighted mean formation rate of adhesions after abdominal surgery was 54 % (95 % confidence interval [CI] 40-68 %), and was 66 % (95 % CI 38-94 %) after gastrointestinal surgery, 51 % (95 % CI 40-63 %) after obstetric and gynaecological surgery and 22 % (95 % CI 7-38 %) after urological surgery. The mean overall severity score was 1.11 ± 0.98 according to the Operative Laparoscopy Study Group classification. Laparoscopic surgery reduced the adhesion formation rate by 25 % and decreased the adhesion severity score (laparoscopic; 0.36 ± 0.69 vs. open; 2.14 ± 0.84) for gastrointestinal surgery. Our results demonstrate that the incidence and severity of abdominal adhesions varies between surgical specialties and procedures. An increased awareness of adhesions can help in identifying the underlying mechanisms of adhesion formation and novel therapeutic approaches, while also improving the surgical consent process.
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Tarney CM. Bladder Injury During Cesarean Delivery. CURRENT WOMEN'S HEALTH REVIEWS 2013; 9:70-76. [PMID: 24876830 PMCID: PMC4033551 DOI: 10.2174/157340480902140102151729] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/21/2013] [Revised: 06/07/2013] [Accepted: 06/17/2013] [Indexed: 11/22/2022]
Abstract
Cesarean section is the most common surgery performed in the United States with over 30% of deliveries occurring via this route. This number is likely to increase given decreasing rates of vaginal birth after cesarean section (VBAC) and primary cesarean delivery on maternal request, which carries the inherent risk for intraoperative complications. Urologic injury is the most common injury at the time of either obstetric or gynecologic surgery, with the bladder being the most frequent organ damaged. Risk factors for bladder injury during cesarean section include previous cesarean delivery, adhesions, emergent cesarean delivery, and cesarean section performed at the time of the second stage of labor. Fortunately, most bladder injuries are recognized at the time of surgery, which is important, as quick recognition and repair are associated with a significant reduction in patient mortality. Although cesarean delivery is a cornerstone of obstetrics, there is a paucity of data in the literature either supporting or refuting specific techniques that are performed today. There is evidence to support double-layer closure of the hysterotomy, the routine use of adhesive barriers, and performing a Pfannenstiel skin incision versus a vertical midline subumbilical incision to decrease the risk for bladder injury during cesarean section. There is also no evidence that supports the creation of a bladder flap, although routinely performed during cesarean section, as a method to reduce the risk of bladder injury. Finally, more research is needed to determine if indwelling catheterization, exteriorization of the uterus, and methods to extend hysterotomy incision lead to bladder injury.
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Affiliation(s)
- Christopher M. Tarney
- Womack Army Medical Center, Department of Obstetrics and Gynecology, 2817 Reilly Road, Fort Bragg, NC 28307, USA
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14
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Bates GW, Shomento S. Adhesion prevention in patients with multiple cesarean deliveries. Am J Obstet Gynecol 2011; 205:S19-24. [PMID: 22114994 DOI: 10.1016/j.ajog.2011.09.030] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2011] [Revised: 08/09/2011] [Accepted: 09/29/2011] [Indexed: 11/18/2022]
Abstract
Adhesion formation is a well-known complication of abdominal surgery. Although one third of all deliveries in the United States are by cesarean delivery (CD), little is known about adhesions in the obstetric setting. Various surgical techniques for reducing adhesion formation following CD have been investigated. The relative benefits of peritoneal closure and single-layer uterine closure are areas of continued research and debate. Adhesion prevention products are also becoming more commonplace in gynecologic surgery. Two membrane/adhesion barriers have been approved in the United States. A barrier consisting of oxidized regenerated cellulose (Interceed absorbable adhesion barrier) has been shown to reduce adhesions during microsurgery. Its use may be limited following CD because complete hemostasis is crucial to its efficacy. Seprafilm adhesion barrier, composed of hyaluronic acid and carboxymethylcellulose, is approved for use in abdominal or pelvic laparotomy. Preliminary data suggest that it may be effective for reducing adhesions following CD. This article discusses what is currently known about adhesion prevention in the obstetric population and highlights the paucity of level I evidence available to clinicians in this setting.
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Affiliation(s)
- Gordon Wright Bates
- Department of Obstetrics and Gynecology, University of Alabama-Birmingham, Birmingham, AL 35233, USA.
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15
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Lyell DJ. Adhesions and perioperative complications of repeat cesarean delivery. Am J Obstet Gynecol 2011; 205:S11-8. [PMID: 22114993 DOI: 10.1016/j.ajog.2011.09.029] [Citation(s) in RCA: 65] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2011] [Revised: 09/26/2011] [Accepted: 09/29/2011] [Indexed: 01/26/2023]
Abstract
The unprecedented high rate of cesarean delivery and the declining rate of vaginal birth after cesarean delivery make necessary awareness of the potential complications that are associated with repeat cesarean delivery. This article reviews the epidemiologic features of cesarean delivery and the perioperative risks that are associated with repeat cesarean delivery. These risks include increased adhesions, infections and wound complications, bleeding, bowel injury and obstruction, hysterectomy, operative time, hospital stay, and delays in delivery.
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16
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Greenberg MB, Daniels K, Blumenfeld YJ, Caughey AB, Lyell DJ. Do adhesions at repeat cesarean delay delivery of the newborn? Am J Obstet Gynecol 2011; 205:380.e1-5. [PMID: 21864825 DOI: 10.1016/j.ajog.2011.06.088] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2011] [Revised: 05/03/2011] [Accepted: 06/22/2011] [Indexed: 11/26/2022]
Abstract
OBJECTIVE We sought to assess whether the presence and severity of adhesions at first repeat cesarean delivery are associated with delayed delivery of the newborn. STUDY DESIGN We conducted secondary analysis of a prospective cohort of women undergoing first repeat cesarean. Severity and location of adhesions were reported by surgeons immediately postoperatively. We compared adhesion density scores with delivery data. RESULTS Of 145 women analyzed, 92 (63.5%) had adhesions and 53 (36.5%) did not. Mean incision to delivery time in women with adhesion scores >3 was 19.8 minutes, compared to 15.6 minutes with scores ≤ 3 (P = .04). More women with adhesion scores >3 remained undelivered at 30 minutes after incision compared to scores ≤ 3 (17.9% vs 5.1%; odds ratio, 7.6; 95% confidence interval, 1.6-34.5), after controlling for potential confounders. CONCLUSION Among women undergoing first repeat cesarean, severity of adhesions may delay delivery of the newborn. Study of techniques to reduce adhesions may be warranted to prevent delayed delivery at repeat cesarean.
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17
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Awonuga AO, Fletcher NM, Saed GM, Diamond MP. Postoperative adhesion development following cesarean and open intra-abdominal gynecological operations: a review. Reprod Sci 2011; 18:1166-85. [PMID: 21775773 DOI: 10.1177/1933719111414206] [Citation(s) in RCA: 57] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
In this review, we discuss the pathophysiology of adhesion development, the impact of physiological changes associated with pregnancy on markers of adhesion development, and the clinical implications of adhesion development following cesarean delivery (CD). Although peritoneal adhesions develop after the overwhelming majority of intra-abdominal and pelvic surgery, there is evidence in the literature that suggests that patients having CD may develop adhesions less frequently. However, adhesions continue to be a concern after CD, and are likely significant, albeit on average less than after gynecological operations, but with potential to cause significant delay in the delivery of the baby with serious, lifelong consequences. Appreciation of the pathophysiology of adhesion development described herein should allow a more informed approach to the rapidly evolving field of intra-abdominal adhesions and should serve as a reference for an evidence-based approach to consideration for the prevention and treatment of adhesions.
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Affiliation(s)
- Awoniyi O Awonuga
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, MI 48201, USA
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El-Shawarby SA, Salim R, Lavery S, Saridogan E. Uterine adherence to anterior abdominal wall after caesarean section. BJOG 2011; 118:1133-5. [DOI: 10.1111/j.1471-0528.2011.02965.x] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Shi Z, Ma L, Yang Y, Wang H, Schreiber A, Li X, Tai S, Zhao X, Teng J, Zhang L, Lu W, An Y, Alla NR, Cui T. Adhesion formation after previous caesarean section-a meta-analysis and systematic review. BJOG 2010; 118:410-22. [DOI: 10.1111/j.1471-0528.2010.02808.x] [Citation(s) in RCA: 52] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Dense adhesions between the uterus and anterior abdominal wall: a unique complication of Cesarean delivery. ACTA ACUST UNITED AC 2010. [DOI: 10.1007/s10397-010-0633-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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