# Impact of severe intra‐abdominal adhesions on early maternal complications following cesarean delivery

## TL;DR

Severe intra-abdominal adhesions increase the risk of early maternal complications after cesarean delivery.

## Contribution

This study is the first large prospective observational analysis linking severe adhesions to specific maternal complications after cesarean delivery.

## Key findings

- Women with severe adhesions had a 28% higher risk of maternal complications after cesarean delivery.
- Severe adhesions were independently associated with increased need for blood or iron products and prolonged hospitalization.
- No significant differences were found in fever, re-hospitalization, or emergency room visits between groups.

## Abstract

The rising rates of cesarean delivery (CD), which are a leading cause of intra‐abdominal adhesions, represent a major concern for maternal health. We aimed to describe early maternal complications following CD in women with severe intra‐abdominal adhesions.

A prospective observational study was conducted at a university‐affiliated tertiary medical center (January 2021 and March 2023) in Israel. Women who underwent CD were assessed for intra‐abdominal adhesions by questionnaires completed by the surgeons. Adhesions were evaluated at four anatomical sites: abdomen‐to‐uterus, uterus‐to‐bladder, skin‐to‐fascia, and other intra‐abdominal sites. Each site was scored on a scale of 0–2, with a total score ranging from 0 to 8. Severe adhesions were defined as a total score ≥5. The primary outcome measures were a composite complication which included at least one or more of postoperative need for blood or iron products, fever, prolonged hospitalization, re‐hospitalization, and emergency room visits.

Overall, 2797 women were included in the study, of whom 295 (10.6%) exhibited severe adhesions. Women with severe adhesions had a higher composite risk for maternal complications following CD (RR = 1.28, 95% confidence interval [CI]: 1.12–1.45, P < 0.001), specifically, postoperative need for blood or iron products (RR = 1.71, 95% CI: 1.15–2.55, P = 0.007) and prolonged hospitalization (RR = 1.49, 95% CI: 1.10–2.03, P = 0.009). There were no significant group differences in the rates of postoperative fever, re‐hospitalization or emergency room visits. In multivariate analysis, severe adhesions had an independent impact on maternal complications (CI: 1.06–1.95, P value 0.017).

Severe intra‐abdominal adhesions diagnosed in CD had an impact on early maternal complications.

Exploring severe intra‐abdominal adhesions impact on early maternal complications post‐cesarean delivery in a large, prospective observational study, revealed a significant impact.