Evaluation of Previous Cesarean Section as a Risk Factor for Severe Intra-Abdominal Adhesions During Subsequent Pelvic Surgery: A Comparative Cross-Sectional Study

Abstract

Background: Intra-abdominal adhesions may result from previous cesarean section (CS) and may increase the complexity and morbidity of subsequent pelvic surgery. This study evaluated previous CS as a risk factor for severe intra-abdominal adhesions.

Material and Methods: A comparative cross-sectional study was conducted among 80 women undergoing pelvic surgery, including 40 with and 40 without previous CS. Participants were recruited consecutively. Intraoperatively, adhesions were graded by their density and by their impact on the normal anatomy. Data were collected and analyzed in SPSS version 26, and demographic, obstetric, and operative variables were recorded. Chi-square/Fisher's exact tests, odds ratios, and binary logistic regression were used to assess associations.

Results: There was a statistically significant difference in adhesions between women with (55.0%) and without (20.0%) prior CS (p=0.002). Severe adhesions occurred in 25.0% and 5.0%, respectively (p=0.012). Severe adhesions increased from 13.0% after one CS to 33.3% after two and 60.0% after ≥3 CS (p=0.018). The estimated blood loss and operative time were significantly greater among women with previous CS. Previous CS was also independently associated with severe adhesions (p=0.034).

Conclusion: Previous CS was significantly associated with severe intra-abdominal adhesions during subsequent pelvic surgery. Increasing risk was associated with repeated CS and also with increased operative difficulty.

Keywords: Cesarean section; intra-abdominal adhesions; pelvic surgery