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- Title
Abdominal adhesions in gynaecologic surgery after caesarean section: a longitudinal population-based register study.
- Authors
Hesselman, S.; Högberg, U.; Råssjö, E‐B; Schytt, E.; Löfgren, M.; Jonsson, M.; Råssjö, E-B
- Abstract
<bold>Objective: </bold>The aim of the study was to evaluate the association between abdominal adhesions at the time of gynaecologic surgery and a history of caesarean delivery, and to investigate obstetric factors contributing to adhesion formation after caesarean section (CS).<bold>Design: </bold>Longitudinal population-based register study.<bold>Setting: </bold>Sweden.<bold>Population: </bold>Women undergoing benign hysterectomy and/or adnexal surgery in Sweden, 2000-2014, with a previous delivery during 1973-2013 (n = 15 479).<bold>Methods: </bold>Information about abdominal adhesions during gynaecological surgery, prior medical history, pregnancies and deliveries were retrieved from Swedish National Health and Quality registers.<bold>Main Outcome Measures: </bold>Adhesions.<bold>Results: </bold>In women with previous CS, adhesions were present in 37%, compared with 10% of women with no previous CS [odds ratio (OR): 5.18, 95% confidence interval (CI): 4.70-5.71]. Adhesions increased with the number of caesarean sections: 32% after one CS; 42% after two CS and 59% after three or more CS (P < 0.001). Regardless of the number of CS, factors at CS such as age ≥35 years (aOR: 1.28, 95% CI: 1.05-1.55), body mass index (BMI) ≥30 [adjusted OR (aOR): 1.91, 95% CI: 1.49-2.45] and postpartum infection (aOR: 1.55, 95% CI: 1.05-2.30) increased the risk of adhesions.<bold>Conclusions: </bold>Presence of adhesions in abdominal gynaecological surgery is associated with women's personal history of caesarean delivery. The number of caesarean sections was the important predictor of adhesions; advanced age, obesity and postpartum infection further increased the incidence.<bold>Tweetable Abstract: </bold>Repeat caesarean, age, obesity and infection increased the risk of pelvic adhesions after caesarean section.
- Subjects
SWEDEN; CESAREAN section; GYNECOLOGY; BODY mass index; PELVIC abnormalities; ADNEXAL diseases; OBESITY complications; ABDOMEN; TISSUE adhesions; AGE distribution; GYNECOLOGIC surgery; HYSTERECTOMY; LONGITUDINAL method; PSYCHOLOGICAL tests; SOCIAL networks; GASTRIC diseases; SURGICAL complications; ACQUISITION of data; ODDS ratio; FERRANS &; Powers Quality of Life Index
- Publication
BJOG: An International Journal of Obstetrics & Gynaecology, 2018, Vol 125, Issue 5, p597
- ISSN
1470-0328
- Publication type
journal article
- DOI
10.1111/1471-0528.14708