Friday, June 01, 2007

Cesarean section adhesions linked with delayed delivery

In the latest AJOG is a retrospective study assessing the risks of pelvic adhesive disease after cesarean section and its impact on delivery.

The study found that 4 percent of women undergoing primary cesarean delivery had documented adhesions. This rose to 46 percent in the 217 women with a second cesarean section, 75 percent of the 64 women undergoing a third cesarean delivery, and 83 percent of the six women undergoing a fourth cesarean section.

The mean time from skin incision to delivery of the infant was 10.7 minutes in a primary delivery, and this lengthened by 5.6, 8.5, and 18.1 minutes for a second, third, and fourth cesarean birth, respectively.

Morales et al conclude: “Each additional cesarean delivery, with the associated increase in the severity of pelvic adhesive disease, delays delivery of the infant and may compromise fetal health.

Morales et al. Cesarean section adhesions linked with delayed delivery. American Journal of Obstetrics and Gynecology 2007; 196: 461.e1-e6”


I found this interesting as I have 'significant adhesions' from my three cesareans and it is well known in obstetrics that any subsequent cesarean delivery is like working through 'cement' (term used by obstetrician friends) because of the scar tissue. I would like to put forward that not only does scar tissue increase delivery time of surgical deliveries, it may have an impact on vaginal delivery as well. If there were pelvic adhesions, could this not possibly slow fetal descent? I can attest to the fact that it can significantly increase pain, what a huge difference in labour pain with adhesions compared to without, so could adhesions have further impact on vaginal as well? Hmm...