Prevalence and Risk Factor of Postoperative Adhesions Following Repeated Cesarean Section
Abstract
Background: Intrauterine adhesion (IUA) typically occurs as a result of intrauterine trauma associated with a surgical procedure. This study aimed to assess the prevalence and risk factors of postoperative adhesions following repeated cesarean sections.
Methods: In this registry-based study, data collection tools included a standardized registry checklist and the American Fertility Society (AFS) classification system for assessing IUA. The diagnosis of IUA was confirmed by an obstetrician-gynecologist, and the AFS scoring was performed by trained researchers responsible for completing the registry data. This study specifically focused on patients who were admitted to the Intensive Care Unit (ICU) of Ayatollah Taleghani Hospital in Ilam following their second cesarean delivery (CD). Within a defined timeframe, the incidence of IUA among these ICU-admitted patients was evaluated. The collected data were subsequently analyzed using SPSS statistical software.
Results: According to the findings, out of 121 hospitalized patients, 35 (28.92%) patients were diagnosed with IUA. Out of 35 patients, 15 (42.9%) patients were in Stage I (mild), 13 (37.1%) patients were in Stage II (moderate), and 7 (20%) patients were in Stage III (severe). also, there was no difference between any of the variables in Table 1 and the stage of adhesions (P>0.05).
Conclusion: Given that the rate of IUA has been significant, it is recommended that necessary preventive and therapeutic interventions be implemented to reduce its incidence, contributing factors, and related complications.
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[23] Nikpay S, Otaghi M, Azami M, Karimi M, Abdi J. Trichomonas Vaginalis Infection Among Women Attending Laboratory Centers in Ilam, Iran. Infect Disord Drug Targets. 2020;20: 98-101.
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[26] Kuzel D, Horak P, Hrazdirova L, Kubinova K, Sosna O, Mara M. “See and treat” hysteroscopy after missed abortion. Minim Invasive Ther Allied Technol. 2011;20: 14-17.
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[28] Salzani A, Yela D A, Gabiatti J R E, Bedone A J, Monteiro I. M. U. Prevalence of uterine synechia after abortion evacuation curettage. Sao Paulo Med J. 2007;125: 261-264.
[29] Nuamah M A, Browne J L, Öry A V, Damale N, Klipstein-Grobusch K, Rijken M J. Prevalence of adhesions and associated postoperative complications after cesarean section in Ghana: a prospective cohort study. Reprod Health. 2017;14: 143.
[30] Kasiulevičius V, Šapoka V, Filipavičiūtė R. Sample size calculation in epidemiological studies. Gerontologija. 2006; 7: 225-231.
[31] Nisenblat V., Barak S., Griness O. B., Degani S., Ohel G., Gonen R. Maternal complications associated with multiple cesarean deliveries. Obstet Gynecol. 2006;108: 21-26.
[32] Walfisch A, Beloosesky R, Shrim A, Hallak M. Adhesion prevention after cesarean delivery: evidence, and lack of it, Am J Obstet Gynecol 2014: 211: 446-452.
[33] Kwawukume E Y. Caesarean section in developing countries. Best Pract Res Clin Obstet Gynaecol. 2001;15: 165-178.
[34] Yaghmaei M, Darvish S, Farmanbar S M. Cesarean Section Scar Characteristics in Subjects with and without Intra-abdominal Adhesions at Taleghani Hospital in Tehran, Iran in 2016. Iran J Obstet Gynecol Infertil. 2018; 21: 1-6.
[35] Dehghani Firouzabadi R, Shafa S, Yazdian Anari P, Vaghefi M. Adhesion Following First-Time C-Section and its Effects on Mother and Neonate in Patients Admitted to Shahid Sadoughi Hospital in Yazd during 2012-2014. J Shahid Sadoughi Univ Med Sci. 2015; 23: 1776-1782.
[2] Olza I, Uvnas-Moberg K, Ekström-Bergström A, Leahy-Warren P, Karlsdottir S. I, Nieuwenhuijze M, et al. Birth as a neuro-psycho-social event: An integrative model of maternal experiences and their relation to neurohormonal events during childbirth, PLoS One. 2020;15: e0230992.
[3] Zhang K, Dai L, Wu M, Zeng T, Yuan M, Chen Y. Women’s experience of psychological birth trauma in China: a qualitative study. BMC Pregnancy and Childbirth. 2020;20: 651.
[4] Salehi A, Fahami F, Aghaei N, Beigi M. The role of husband on satisfaction of childbirth: an approach to promote natural childbirth. Iran J Obstet Gynecol Infertil. 2024;27: 53-62.
[5] Suherman R W P, Akbar M I A. Maternal and perinatal outcomes in obese pregnant women. J Med Pharm Chem Res. 2025;7: 1336-1348.
[6] Nabilah H, Akbar M I A, Joewono H T. The differences of risk factors and outcomes of pregnancy with obesity who had failed and successful induction of labor in 2023. J Med Pharm Chem Res. 2025;7: 1503-1512.
[7] Faghih N, Aliari H, Hoseini S, Yaghmaei M, Ghiasi F. The relationship between re-approximation of rectus abdominis muscle during caesarean section and the amount of postoperative pain, thickness and distance of abdominal wall muscles. Iran J Obstet Gynecol Infertil. 2024;27: 23-30.
[8] Pirdadeh Beiranvand S, Behboodi Moghaddam Z, Hasani M, Beiranvand S, Beygizadeh A. Fear of natural childbirth and its related factors among primigravid women: a mixed-methods study. Iran J Obstet Gynecol Infertil. 2024; 27: 21-36.
[9] Ningrum D, Wardhana M P, Marcionara N I C, Aditiawarman A. A challenge in managing fetal congenital total avb with negative anti-ro and anti-la and positive anti nuclear antibody pregnant woman: A case report. J Med Pharm Chem Res. 2024;6: 1637-1642.
[10] Thakur B N, Satpathy I, Patnaik B C M., Kumar A. Artificial intelligence (AI): Transformation in gestational diabetes mellitus (GDM) treatment in india. J Med Pharm Chem Res. 2024; 6: 456-565.
[11] Siddiqui M Z, Goli S, Reja T, Doshi R, Chakravorty S, Tiwari C, et al. Prevalence of anemia and its determinants among pregnant, lactating, and nonpregnant nonlactating women in India. Sage Open. 2017;7: 2158244017725555.
[12] Lin L, Wei Y, Zhu W, Wang C, Su R, Feng H, et al. Prevalence, risk factors and associated adverse pregnancy outcomes of anaemia in Chinese pregnant women: a multicentre retrospective study. BMC Pregnancy Childbirth. 2018; 18: 111.
[13] Mortazavi Z, Khammari Z. The effect of maternal iron deficiency anemia during pregnancy on infants’ anthropometric indices at birth. Iran J Obstet Gynecol Infertil. 2024;27: 17-28.
[14] Vieira F, Bachion M M, Mota D D, Munari D B. A systematic review of the interventions for nipple trauma in breastfeeding mothers. J Nurs Scholarsh. 2013; 45: 116-125.
[15] Koushki M, Mojab F, Mohammadi R, Alamolhoda S H. The effect of ostrich oil and breast milk on healing of breast fissures in lactating primiparous women. Iran J Obstet Gynecol Infertil. 2024;27: 47-59.
[16] Umesawa M, Kobashi G. Epidemiology of hypertensive disorders in pregnancy: prevalence, risk factors, predictors and prognosis. Hypertens Res. 2017; 40: 213-220.
[17] Shen M, Duan H, Chang Y, Lin Q. Prevalence and risk factors of intrauterine adhesions in women with a septate uterus: a retrospective cohort study. Reprod Biomed Online. 2022;44: 881-887.
[18] Fuchs N, Smorgick N, Ben Ami I, Vaknin Z, Tovbin Y, Halperin R. et al. Intercoat (Oxiplex/AP gel) for preventing intrauterine adhesions after operative hysteroscopy for suspected retained products of conception: double-blind, prospective, randomized pilot study. J Minim Invasive Gynecol. 2014;21: 126-130.
[19] Lee W L, Liu C H, Cheng M, Chang W H, Liu W M, Wang P H. Focus on the Primary Prevention of Intrauterine Adhesions: Current Concept and Vision. Int J Mol Sci. 2021; 22.
[20] Doroftei B, Dabuleanu A M, Ilie O D, Maftei R, Anton E, Simionescu G, et al. Mini-Review of the New Therapeutic Possibilities in Asherman Syndrome-Where Are We after One Hundred and Twenty-Six Years?, Diagnostics (Basel). 2020; 10.
[21] Wang Y Q, Song X H, Wu S L, Huang Y Z, Yan L, Li C Z. Comparison of Autocross-Linked Hyaluronic Acid Gel and Intrauterine Device for Preventing Intrauterine Adhesions in Infertile Patients: A Randomized Clinical Trial. Gynecol Minim Invasive Ther. 2020;9: 74-80.
[22] Adhesions A. The American Fertility Society classifications of adnexal adhesions, distal tubal occlusion, tubal occlusion secondary to tubal ligation, tubal pregnancies, Müllerian anomalies and intrauterine adhesions. Fertil Steril. 1988;49: 944.
[23] Nikpay S, Otaghi M, Azami M, Karimi M, Abdi J. Trichomonas Vaginalis Infection Among Women Attending Laboratory Centers in Ilam, Iran. Infect Disord Drug Targets. 2020;20: 98-101.
[24] Cogendez E, Dolgun Z N, Sanverdi I, Turgut A, Eren S. Post-abortion hysteroscopy: a method for early diagnosis of congenital and acquired intrauterine causes of abortions. Eur J Obstet Gynecol Reprod Biol. 2011;156: 101-104.
[25] Wang X, Li Z, Yn A, Zou S. Hysteroscopy for early abortion after IVF-ET: clinical analysis of 84 cases. Zhonghua nan ke xue= National Journal of Andrology. 2011;17: 52-54.
[26] Kuzel D, Horak P, Hrazdirova L, Kubinova K, Sosna O, Mara M. “See and treat” hysteroscopy after missed abortion. Minim Invasive Ther Allied Technol. 2011;20: 14-17.
[27] Yasar L, Sonmez S, Koc S, Cebi Z, Kupelioglu L, Toklar A, et al. Prophylactic estrogen administration for preventing intrauterine adhesion formation following missed abortions. Jinekoloji ve Obstetrik Dergisi. 2004;18: 154-157.
[28] Salzani A, Yela D A, Gabiatti J R E, Bedone A J, Monteiro I. M. U. Prevalence of uterine synechia after abortion evacuation curettage. Sao Paulo Med J. 2007;125: 261-264.
[29] Nuamah M A, Browne J L, Öry A V, Damale N, Klipstein-Grobusch K, Rijken M J. Prevalence of adhesions and associated postoperative complications after cesarean section in Ghana: a prospective cohort study. Reprod Health. 2017;14: 143.
[30] Kasiulevičius V, Šapoka V, Filipavičiūtė R. Sample size calculation in epidemiological studies. Gerontologija. 2006; 7: 225-231.
[31] Nisenblat V., Barak S., Griness O. B., Degani S., Ohel G., Gonen R. Maternal complications associated with multiple cesarean deliveries. Obstet Gynecol. 2006;108: 21-26.
[32] Walfisch A, Beloosesky R, Shrim A, Hallak M. Adhesion prevention after cesarean delivery: evidence, and lack of it, Am J Obstet Gynecol 2014: 211: 446-452.
[33] Kwawukume E Y. Caesarean section in developing countries. Best Pract Res Clin Obstet Gynaecol. 2001;15: 165-178.
[34] Yaghmaei M, Darvish S, Farmanbar S M. Cesarean Section Scar Characteristics in Subjects with and without Intra-abdominal Adhesions at Taleghani Hospital in Tehran, Iran in 2016. Iran J Obstet Gynecol Infertil. 2018; 21: 1-6.
[35] Dehghani Firouzabadi R, Shafa S, Yazdian Anari P, Vaghefi M. Adhesion Following First-Time C-Section and its Effects on Mother and Neonate in Patients Admitted to Shahid Sadoughi Hospital in Yazd during 2012-2014. J Shahid Sadoughi Univ Med Sci. 2015; 23: 1776-1782.
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How to Cite
1.
Azimi B, Karimian M, Ariana S. Prevalence and Risk Factor of Postoperative Adhesions Following Repeated Cesarean Section. Arch Anesth & Crit Care. 2025;.
