Abstract
Objective
To investigate whether the presence of peritoneal adhesions during a second cesarean
delivery resulting from the first cesarean delivery, are associated with peri- and
post-partum infectious morbidity.
Study Design
A retrospective cohort study was undertaken, comparing maternal peri- and immediate
post-partum infectious morbidity during the second cesarean delivery, between women
with and without adhesions resulting from the first cesarean delivery. All women over
18 years old at their second cesarean delivery, with a singleton pregnancy between
the years 1988–2016 were included in the analysis. Patients with previously diagnosed
adhesions during the first cesarean delivery, a history of other abdominal or pelvic
surgery, pelvic infection or pelvic inflammatory disease, endometriosis, uterine Mullerian
anomalies, and births of newborns with known chromosomal or structural abnormalities
were excluded from the analysis, resulting in a study population of 7925 women. Infectious
morbidity was defined as a composite of chorioamnionitis, post-partum fever, urinary
tract infection and surgical wound infection or disruption. In order to identify factors
that are independently associated with infectious morbidity, multivariate logistic
regression analyses were constructed to control for potential confounders.
Results
During the study period, 32.6% (n = 2581) women were diagnosed with adhesions at the
second cesarean delivery. Second cesarean deliveries complicated with adhesions were
characterized by higher rates of peri- and post-partum maternal infectious morbidity
(6.5% vs. 9%, p < 0.001). Our study population comprises two ethnic groups- Jewish
(54.3%) and Bedouin Arabs (45.7%). We have tested interactions with adhesions of all
predictor variables in the model. Since we found a strong interaction between adhesions
and ethnicity, stratified data are presented. Infectious morbidity was significantly
associated with the presence of peritoneal adhesions only among Jewish women (adjusted
OR 2.09, PV < 0.001, 95% CI 1.56–2.80), adjusting for potential confounding variables
and significant interactions.
Conclusion
Cesarean delivery complicated with adhesions attributable to a previous cesarean delivery,
increase the risk for peri- and immediate post-partum infectious morbidity among Jewish
women.
Keywords
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Article info
Publication history
Published online: August 10, 2019
Accepted:
August 5,
2019
Received in revised form:
August 2,
2019
Received:
June 12,
2019
Identification
Copyright
© 2019 Elsevier B.V. All rights reserved.
