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  4. Implication of adhesiolysis in repeat cesarean section in low resources settings. Prospective cohort clinical study

Implication of adhesiolysis in repeat cesarean section in low resources settings. Prospective cohort clinical study

Authors

Sayad Asrar Saleh
Balafair, Amer Salmen
Mitwaly, Abo Bakr Abass
Hadhramout University ; , Faculty of Medicine ; ,

Assiut Med. J. 2015; 39 (3): 181-186
Assiut Medical Journal
Journal Country: Egypt
P-ISSN: 1110-0494
Type of Publication: Journal Article
Category: Humans, Female,
Country of Research: Yemen WHO Eastern Mediterranean Region
Type of Research: Clinical
Keywords: Cesarean Section, Repeat
Broad Subjects: Maternal, Reproductive and Child Health, Cesarean Section ,Prospective Studies ,Cohort Studies ,Pregnancy ,Tissue Adhesions
Citation: Asrar Saleh Sayad ,Amer Salmen Balafair ,Abo Bakr Abass Mitwaly , Implication of adhesiolysis in repeat cesarean section in low resources settings. Prospective cohort clinical study, Assiut Med. J. 2015; 39 (3): 181-186

Abstract English

Introduction: Adhesions formed after cesarean section varies according the number of repeat section. Delivery times were reported to be increase with increased number of cesarean section due to increase adhesion frequencies and density. This can induce effect upon Apgar score of the new born. Pelvic adhesions can influence the maternal morbidity which can occur in women with repeat cesarean section. Incision to delivery time affect and was effected by doing or not doing adhesiolysis Material and Methods: This is a prospective cohort study to evaluate the implication of doing adhesiolysis during laparotomy of repeat cesarean section either before delivery of the fetus or after that. The study was done at El-Mukala maternal and child hospital and Hadhramout maternal and child university hospital in the period from October 2012 to October 2015 to evaluate use of this maneuver with ascending curve of experience instead of use of anti-adhesion substances which is costly and also not available in low economic society. Our evaluation was related to maternal and perinatal morbidity factors. The operative procedure was explained in details. Statistical analysis was done using SPSS Software 22. Chi square test and student T test was used
Results: Adhesiolysis was done in 50 patients out of them: 13 had previous two cesarean sections, 28 had previous three cesarean sections, 8 had previous four cesarean sections and 1 had previous five cesarean sections. The dominant type of adhesions was omental, bladder and uterine adhesion forming bands with anterior abdominal wall. The utero vesical adhesions were present in all cases. No maternal morbidity occurred during adhesiolysis, and other maternal morbidity unrelated to adhesion [common obstetrics complications like bladder injury] did not occur. The percentage of cases with decreased Apgar score as 25 cases [50%] due to adhesiolysis related to delay in delivery of the fetus No perinatal mortality load occurred. The need for post-operative analgesia in spite of use of intra thecal morphine was in 5 cases [10%] . Post-operative spinal headache was in 10 cases [20%] no cases of wound infection or endomeritis

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