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Open Access 01-12-2021 | Sectio Ceasarea | Research article

Prediction of intraperitoneal adhesions using striae gravidarum and scar characteristics in women undergoing repeated cesarean sections

Authors: Mohamed Elprince, Omima T. Taha, Zakia M. Ibrahim, Rasha E. Khamees, Mahmoud A. Greash, Khaled A. Atwa, Ahmed M. Gadallah, Noha al-Okda, Radwa M. Abdel Aal, Mohamed F. Ibrahim, Ahmed A. Aboelroose, Osama E. Ashour, Asmaa M. Elgedawy, Amira M. Elbahie, Hanan M. Ghoneim, Amal A. Ahmed

Published in: BMC Pregnancy and Childbirth | Issue 1/2021

Abstract

Background

The current fact of increasing rates of cesarean deliveries is a catastrophe. Recurrent cesareans result in intraperitoneal adhesions that would lead to maternal morbidity during delivery. Great efforts are directed towards the prediction of intraperitoneal adhesions to provide the best care for laboring women. The aim of the current study was to evaluate the role of abdominal striae and cesarean scar characters in the prediction of intraperitoneal adhesions.

Methods

This was a case- control study conducted in the emergency ward of the obstetrics and gynecology department of a tertiary hospital from June to December 2019. The study was carried on patients admitted to the ward fulfilling particular inclusion and exclusion criteria. The study included two groups, group one was assessed for the presence of striae, and the degree of intraperitoneal adhesions was evaluated during the current cesarean section. Group two included patients without evidence of abdominal striae. They were evaluated for the severity of adhesions also after evaluation of the previous scar. Evaluation of the striae was done using Davey’s scoring system. The scar was assessed using the Vancouver Scar Scale. The modified Nair’s scoring system was used to evaluate intraperitoneal adhesions.

Results

The study group included 203 women, while the control group included 205 women. There were significant differences in the demographic characters of the recruited patients (p-value 0.001 for almost all variables). The mean Davey score in those with mild, moderate, and severe striae was 1.82 ± 0.39, 3.57 ± 0.5, and 6.73 ± 0.94, respectively (p-value < 0.001). Higher scores for the parameters of the Vancouver scale were present in patients with severe striae (1.69 ± 1.01, 1.73 ± 0.57, 2.67 ± 1.23, and 1.35 ± 1.06 for scar vascularity, pigmentation, pliability, and height respectively with a p-value of < 0.001 each). Thick intraperitoneal adhesions were noted significantly in women with severe striae [21 (43.75%), p-value < 0.001)]. The Davey’s and Vancouver scores showed highly significant predictive performance in the prediction of intraperitoneal adhesions (p-value < 0.001).

Conclusion

Abdominal striae and cesarean scar were significant predictors for intraperitoneal adhesions.

Murphy DJ, Stirrat GM, Heron J, ALSPAC Study Team. The relationship between Caesaean section and subfertility in a population-based sample of 14 541 pregnancies. Hum Reprod. 2002;17(7):1914–7. https://doi.org/10.1093/humrep/17.7.1914.CrossRefPubMed

Rossouw JN, Hall D, Harvey J. Time between skin incision and delivery during cesarean. Int J Gynaecol Obstet. 2013;121(1):82–5. https://doi.org/10.1016/j.ijgo.2012.11.008.CrossRefPubMed

Watson REB. Stretching the point: an association between the occurrence of Striae and pelvic relaxation? J Investig Dermatol. 2006;126(8):1688–9. https://doi.org/10.1038/sj.jid.5700316.CrossRefPubMed

Watson RE, Parry EJ, Humphries JD, et al. Fibrillin microfibrils are reduced in skin exhibiting striae distensae. Br J Dermatol. 1998;138(6):931–7. https://doi.org/10.1046/j.1365-2133.1998.02257.x.CrossRefPubMed

Larson A, Nauta K, Kawai M, Longaker H, Lorenz P. Scarring and scarless wound healing. In: Woodhead Publishing Series in Biomaterials; 2011. p. 77–111.

Dogan NU, Haktankacmaz SA, Dogan S, Ozkan O, Celik H, Eryilmaz OG, et al. A reliable way to predict intra-abdominal adhesions at repeat cesarean delivery: Scar characteristics. Acta Obstet Gynecol Scand. 2011;90(2011):531–4. https://doi.org/10.1111/j.1600-0412.2011.01080.x.CrossRefPubMed

Abbas AM, Khalaf M, Abdel-Reheem F, El-Nashar I. Prediction of pelvic adhesions at repeat cesarean delivery through assessment of striae gravidarum score: a cross-sectional study. J Gynecol Obstetrics Hum Reprod. 2020;49(1):101619. https://doi.org/10.1016/j.jogoh.2019.08.002.CrossRef

Cakir Gungor AN, Oguz S, Hacivelioglu S, Isik S, Uysal A, Gencer M, et al. Predictive value of striae gravidarum severity for intraperitoneal adhesions or uterine scar healing in patients with previous caesarean delivery. J Matern Fetal Neonatal Med. 2014;27:1312–5.CrossRef

Celik EY, Ersoy AO, Ersoy E, Yoruk O, Tokmak A, Tasci Y. Is striae gravidarum related to cesarean scar and peritoneal adhesions? PakJ Med Sci. 2018;34(3):568–73.

10.

Jaafar ZA, Obeid RZ, Salman DA. Skin markers and the prediction of intraabdominal adhesion during second cesarean delivery. Ginekol Pol. 2019;90(6):325–30. https://doi.org/10.5603/GP.2019.0059.CrossRefPubMed

11.

Pergialiotis V, Frountzas M, Siotos C, et al. Cesarean wound scar characteristics for the prediction of pelvic adhesions: a meta-analysis of observational studies. J Matern Fetal Neonatal Med. 2017;30(4):486–91. https://doi.org/10.1080/14767058.2016.1176135 indexed in Pubmed: 27072887.CrossRefPubMed

12.

Kokanal D, Kokanal MK, Topcu HO, Ersak B, Tasc Y. Are the cesarean section skin scar characteristics associated with intraabdominal adhesions located at surgical and non-surgical sites. J Gynecol Obstet Hum Reprod. 2019;48(10):839–43. https://doi.org/10.1016/j.jogoh.2019.03.026.CrossRef

13.

Buchanan K, Fletcher HM, Reid M. Prevention of striae gravidarum with cocoa butter cream. Int J Gynaecol Obstet. 2010;108(1):65–8. https://doi.org/10.1016/j.ijgo.2009.08.008.CrossRefPubMed

14.

Sullivan T, Smith J, Kermode J, McIver E, Courtemanche DJ. Rating the burn scar. J Burn Care Rehabil. 1990;11:256–60.CrossRef

15.

Kahyaoglu I, Kayikcioglu F, Kinay T, Mollamahmutoglu L. Abdominal scar characteristics: do they predict intra-abdominal adhesions with repeat cesarean deliveries? J Obstet Gynaecol Res. 2014;40(6):1643–8. https://doi.org/10.1111/jog.12429.CrossRefPubMed

16.

Abd-Elaal NK, El Kelani OA, Saif-Elnasr IA, Elkhyat AM. The relationship between striae gravidarum and intra-abdominal adhesions in pregnant women with previous cesarean section. Int J Curr Res. 2018;10(1):64521–7.

17.

Dogan A, Etras IE, Uyar I, Karaca I, Bozgeyik B, Toz E, et al. Preoperative association of abdominal striae gravidarum with intra-abdominal adhesions in pregnant women with a history of previous cesarean section: a cross-sectional study. Geburtsh Frauenheilk. 2016;76(3):268–72. https://doi.org/10.1055/s-0042-101545.CrossRefPubMed

18.

Khalifi A, Meddeb S, Kouira M, Boukadida A, Hachani F, Chachia S, et al. Post-cesarean parietal scar characteristics are predictive of pelvic adhesions. A prospective cohort study. J Gynecol Obstet Biol Reprod (Paris). 2015;44:621–31.CrossRef

19.

Salim RY, Kadan Z, Nachum Edelstein S, Shalev E. Abdominal scar characteristics as a predictor of intra-abdominal adhesions at repeat cesarean delivery. Fertil Steril. 2008;90(6):2324–7. https://doi.org/10.1016/j.fertnstert.2007.10.037.CrossRefPubMed

20.

Cim N, Elci E, Guneş Elci G, et al. Are the skin scar characteristics and closure of the parietal peritoneum associated with pelvic adhesions? Turk J Obstet Gynecol. 2018;15(1):28–32. https://doi.org/10.4274/tjod.55491 indexed in Pubmed: 29662713.CrossRefPubMedPubMedCentral

Title: Prediction of intraperitoneal adhesions using striae gravidarum and scar characteristics in women undergoing repeated cesarean sections
Authors: Mohamed Elprince
Omima T. Taha
Zakia M. Ibrahim
Rasha E. Khamees
Mahmoud A. Greash
Khaled A. Atwa
Ahmed M. Gadallah
Noha al-Okda
Radwa M. Abdel Aal
Mohamed F. Ibrahim
Ahmed A. Aboelroose
Osama E. Ashour
Asmaa M. Elgedawy
Amira M. Elbahie
Hanan M. Ghoneim
Amal A. Ahmed
Publication date: 01-12-2021
Publisher: BioMed Central
Keywords: Sectio Ceasarea
Sectio Caesarea
Published in: BMC Pregnancy and Childbirth / Issue 1/2021
Electronic ISSN: 1471-2393
DOI: https://doi.org/10.1186/s12884-021-03763-z

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Prediction of intraperitoneal adhesions using striae gravidarum and scar characteristics in women undergoing repeated cesarean sections

Abstract

Background

Methods

Results

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Conclusion

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