Prevalence of pelvic adhesions on ultrasound examination in women with a history of Cesarean section. (26th December 2014)

• Record Type: Journal Article
• Authors: Moro, F.; Mavrelos, D.; Pateman, K.; Holland, T.; Hoo, W. L.; Jurkovic, D.
• Is Part Of: Ultrasound in obstetrics & gynecology. Volume 45:Number 2(2015:Feb.)
• Page Start: 223
• Page End: 228
• Publication Date: 2014-12-26
• Subjects: Ultrasonics in obstetrics -- Periodicals; Generative organs, Female -- Diseases -- Diagnosis -- Periodicals; Diagnosis, Ultrasonic -- Periodicals; Genital Diseases, Female -- ultrasonography -- Periodicals; Ultrasonography, Prenatal -- Periodicals; 618.047543
• DOI: 10.1002/uog.14628
• Languages: English
• ISSNs: 0960-7692

Abstract

<abstract abstract-type="main" id="uog14628-abs-0001"> <title>ABSTRACT</title> <sec id="uog14628-sec-0001" sec-type="section"> <title>Objectives</title> <p id="uog14628-para-0001">To investigate the prevalence and location of pelvic adhesions in women with a history of Cesarean section and to identify risk factors for their formation and symptoms associated with their presence.</p> </sec> <sec id="uog14628-sec-0002" sec-type="section"> <title>Methods</title> <p id="uog14628-para-0002">This was a prospective observational study of women in whom one or more Cesarean sections had been performed > 12 months previously and who attended for a gynecological ultrasound examination. In all women, both transvaginal and transabdominal scans were performed in order to identify the presence of pelvic adhesions. Medical and surgical history was recorded and a structured questionnaire was used to enquire about any history of pelvic pain and urinary symptoms.</p> </sec> <sec id="uog14628-sec-0003" sec-type="section"> <title>Results</title> <p id="uog14628-para-0003">A total of 308 women were recruited into the study. On ultrasound examination, 139 (45.1% (95% CI, 39.7–50.7%)) women showed evidence of adhesions within the pelvis. Adhesions in the vesicouterine pouch were the most common and were found in a total of 79 (25.6% (95% CI, 20.7–30.5%)) women. In women with a history of no surgery other than Cesarean section(s) (<italic>n</italic> = 220), an increasing number of Cesarean sections (odds ratio (OR) 3.4 (95% CI, 2.1–5.5)) and a postoperative wound infection (OR 11.7 (95% CI, 3.5–39.5)) increased the likelihood of adhesions developing in the anterior pelvic compartment. There was a significant association between the presence of anterior compartment adhesions and chronic pelvic pain. Multivariable logistic regression analysis identified anterior abdominal wall adhesions (OR 2.4 (95% CI, 1.0–5.9)) and any adhesions present on ultrasound scan (OR 2.6 (95% CI, 1.2–5.7)) as independent predictors of chronic pelvic pain.</p> </sec> <sec id="uog14628-sec-0004" sec-type="section"> <title>Conclusions</title> <p id="uog14628-para-0004">Pelvic adhesions are present in more than a third of women with a history of Cesarean section and they are associated with chronic pelvic pain. Copyright © 2014 ISUOG. Published by John Wiley & Sons Ltd.</p> </sec> </abstract>