Aboshama Rehab Abdelhamid, Taha Omima T, Abdel Halim Hala Waheed, Elrehim Eman Ibrahim Abd, Kamal Shaimaa Hanafy Moustafa, ElSherbiny Ahmed Mohamed, Magdy Hagar Abdelgawad, Albayadi Eslam, Elsaid Rasha Ezzat, Abdelghany Amany Mohamed, Anan Mohamed A, Abdelfattah Laila Ezzat
Department of Obstetrics and Gynecology, Faculty of Medicine, Fayoum University, Fayoum, Egypt.
Department of Obstetrics and Gynecology, Faculty of Medicine, Suez Canal University, Ismailia, Egypt.
Int J Gynaecol Obstet. 2023 Apr;161(1):234-240. doi: 10.1002/ijgo.14498. Epub 2022 Oct 26.
To evaluate the prevalence of intraperitoneal adhesions after repeated cesarean delivery and its associated personal and surgical risk factors.
This prospective cohort study was conducted at the delivery ward at Fayoum University Hospital from October 2020 to December 2021. Women were recruited according to predetermined inclusion and exclusion criteria. Eligible women were interviewed, and data were obtained for personal history, past surgical and obstetrical history, and data about the current delivery. Nair's scoring system was used to evaluate intraperitoneal adhesions. Postoperative data and complications were reported.
Three hundred women were recruited. Moderate to severe adhesions occurred in 186 patients (62%). These patients had a significantly prolonged hospital stay and were delivered by expert surgeons (P < 0.001 and P = 0.008, respectively). The adhesion score correlated positively with patients' age (P < 0.001), parity (P < 0.001), interpregnancy interval (P = 0.033), duration of hospital admission either previously or in the current delivery (P = 0.001 and P < 0.001), time to ambulation (P < 0.001), time to intestinal movement (P < 0.001), operative time (P < 0.001), and surgeons' age and experience (both P = 0.015).
Adhesions led to increased maternal morbidity. Multiple contributing factors were significantly related to adhesions with multiple cesarean deliveries.
评估再次剖宫产术后腹腔粘连的发生率及其相关的个人和手术风险因素。
这项前瞻性队列研究于2020年10月至2021年12月在法尤姆大学医院产房进行。根据预先确定的纳入和排除标准招募女性。对符合条件的女性进行访谈，获取个人病史、既往手术和产科病史以及当前分娩的数据。采用奈尔评分系统评估腹腔粘连情况。报告术后数据和并发症。
招募了300名女性。186例患者（62%）发生中度至重度粘连。这些患者住院时间显著延长，且由专家外科医生接生（分别为P < 0.001和P = 0.008）。粘连评分与患者年龄（P < 0.001）、产次（P < 0.001）、两次妊娠间隔时间（P = 0.033）、既往或本次分娩的住院时间（P = 0.001和P < 0.001）、下床活动时间（P < 0.001）、肠道蠕动时间（P < 0.001）、手术时间（P < 0.001）以及外科医生的年龄和经验（均为P = 0.015）呈正相关。
粘连导致孕产妇发病率增加。多个促成因素与多次剖宫产术后的粘连显著相关。
