Khlifi A, Meddeb S, Kouira M, Boukadida A, Hachani F, Chachia S, Hidar S, Bibi M, Khairi H, Essaidi H
Service de gynécologie obstétrique, CHU Farhat Hached de Sousse, rue Mohamed-Karoui, CP 4000 Sousse, Tunisie.
Service de gynécologie obstétrique, CHU Farhat Hached de Sousse, rue Mohamed-Karoui, CP 4000 Sousse, Tunisie.
J Gynecol Obstet Biol Reprod (Paris). 2015 Sep;44(7):621-31. doi: 10.1016/j.jgyn.2014.08.007. Epub 2014 Oct 7.
To investigate whether abdominal scar characteristics could predict the incidence and severity of intra-abdominal adhesions found at repeat cesarean delivery.
Prospective cohort study including 151pregnant women with at least one previous cesarean delivery and who delivered abdominally in the department of obstetrics and gynaecology of Farhat Hached teaching hospital-Sousse-Tunisia, during 6 months. Abdominal scar characteristics were studied. The main outcome measure(s) were the incidence and severity of intra-abdominal adhesions. Statistical analysis was performed using SPSS 18.0.
Of 151 women enrolled into this trial, 111 (73.5%) had adhesions, 57 (37.8%) had dense adhesions. Of all the abdominal scar characteristics studied, a depressed scar was associated with an increased incidence of both dense and filmy intra-abdominal adhesions and frozen pelvis if compared of women who did not have a depressed scar (P<10(-4) ; RR=7.6; IC=2.98-19.45). A number of previous cesarean section equal or more than 2 was also correlated with an increased incidence of severe intra-abdominal adhesions and frozen pelvis if compared with women who had only one previous cesarean section (P=0.002; RR=2.53; IC=1.16-5.56).
A depressed abdominal scar of a previous cesarean delivery and a number of previous cesarean sections are significantly correlated with the incidence and severity of intra-abdominal adhesions.
探讨腹部瘢痕特征是否可预测再次剖宫产时腹腔内粘连的发生率及严重程度。
前瞻性队列研究，纳入151例既往至少有一次剖宫产史且在突尼斯苏塞法哈特·哈谢德教学医院妇产科经腹分娩的孕妇，为期6个月。研究腹部瘢痕特征。主要观察指标为腹腔内粘连的发生率及严重程度。使用SPSS 18.0进行统计分析。
在纳入该试验的151例女性中，111例（73.5%）有粘连，57例（37.8%）有致密粘连。在所有研究的腹部瘢痕特征中，与无凹陷瘢痕的女性相比，凹陷瘢痕与致密和薄膜状腹腔内粘连及冰冻骨盆的发生率增加相关（P<10⁻⁴；RR = 7.6；IC = 2.98 - 19.45）。与仅有一次既往剖宫产史的女性相比，既往剖宫产次数等于或超过2次也与严重腹腔内粘连和冰冻骨盆的发生率增加相关（P = 0.002；RR = 2.53；IC = 1.16 - 5.56）。
既往剖宫产的凹陷腹部瘢痕及既往剖宫产次数与腹腔内粘连的发生率及严重程度显著相关。
