(208) Peritoneal adhesions among women with previous cesarean delivery: more than a surgical barrier?

Peritoneal adhesions following cesarean delivery (CD) may impose surgical difficulties and risks in subsequent deliveries, related to changes in pelvic anatomy, longer exposure time, and inadvertent pelvic organ injury. Few investigations, however, have examined their link to birth outcomes. In this study, we have focused on the clinical significance of cesarean-related adhesions for the neonate.

Study Design:

A population-based cohort study was conducted including women with previous CD, who subsequently delivered between the years 1991 to 2021 at a tertiary referral hospital. Fetal and neonatal outcomes were compared between women diagnosed with peritoneal adhesions, and those without adhesions. A general estimation equation (GEE) was applied to control for confounders.

Results:

A total of 49,365 women with previous cesarean delivery (CD) were included in the analyses, 23% of them were diagnosed with peritoneal adhesions. The presence of peritoneal adhesions was associated with adverse perinatal outcomes, including lower Apgar scores at 5 minutes (OR 2.00, 95% CI 1.70-2.36), and postpartum neonatal death (PPD; OR 1.37, 95% CI 1.08-1.75; Table 1). Because women with peritoneal adhesions had higher rates of hypertensive disorders (8.2% vs. 5.4%; p< 0.001), and preterm labor (18.8% vs. 9.6%; p< 0.001), a GEE multivariable analysis investigating independent risk factors for PPD, was applied to evaluate whether the adhesions actually pose such a risk, while controlling for confounders. Unlike earlier gestational age and hypertensive disorders of pregnancy, peritoneal adhesions per-se were not independently associated with postpartum neonatal death (adjusted OR 1.14, 95% CI 0.88-1.49, p=0.317; Table 2).

Conclusion:

Peritoneal adhesions, which could potentially lengthen incision-to-delivery time in urgent CD, are not an independent risk factor for post-partum neonatal death.