The Paucity of Information on Adhesions After Cesarean Delivery
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Background: The widespread use of cesarean sections has made the development of postcesarean adhesions a much more common occurrence. Possible repercussions of postcesarean adhesions include abdominal pain, difficulty in performing surgery, long delivery time for subsequent cesareans, and possibly bowel obstruction. Objective: This review aims to evaluate the occurrence and clinical relevance of adhesions after cesarean delivery and their implications, as well as discussing options for reducing adhesion formation. Design: A literature search was conducted using the keywords cesarean, adhesions, adhesion prevention, and adhesion barrier. This search was conducted in MEDLINE,EMBASE, and the Cochrane Database of Systematic Reviews. All articles were reviewed that related to incidence of adhesions after cesarean section, risk factors, clinical implications, and methods of preventing adhesion formation. Results: It is estimated that more than 1 million cesarean deliveries are performed annually in the United States, representing 31.1% of all deliveries. The widespread use of cesarean sections has made the development of postcesarean adhesions a much more common occurrence. Possible repercussions of postcesarean adhesions include abdominal pain, difficulty in performing surgery, long delivery time for subsequent cesareans, and possibly bowel obstruction. Currently available prophylactic treatment options for adhesion prevention include peritoneal instillates and surgical adhesion barriers. Clinical, anecdotal, and historical experience in other gynecologic settings provide a rationale for the use of adhesion barriers in cesarean deliveries. Conclusions: There is a need for well-designed, prospective randomized studies to evaluate adhesion rates and related complications after cesarean deliveries performed with and without adhesion-reducing substances. Mary Ann Liebert, Inc. 2010.
