Prediction of Intra-abdominal Adhesions at Repeated Cesarean Section by Scar Characteristics

Background: Intra-abdominal adhesions are a common complication after cesarean section, influencing surgical time, blood loss, and outcomes, with reliable preoperative predictors still lacking.
Aim: To investigate exterior cesarean scar features as potential non-invasive indicators of intra-abdominal adhesions in females having recurrent cesarean procedures
Methods: This cross-sectional diagnostic-accuracy research included one hundred full-term pregnant women at Al-Galaa Teaching Hospital and Elsahel Teaching Hospital undergoing elective repeat cesarean sections. Participants have been classified into groups depending on the number of previous cesarean sections. Two blinded observers independently assessed external scar characteristics, including level, type, and pigmentation, using the Observer Scar Assessment Scale (OSAS) and standardizedphotography. The Tulandi and Lyell grading system was employed to assess adhesions during the intraoperative phase. Logistic regression analysis has been employed to evaluate predictors of adhesion presence.
Results: Adhesion prevalence was highest (69%) among women with exactly two prior cesarean sections, significantly higher than those with one (33%) or three or more cesarean sections (50%) (p=0.006). Depressed scar morphology was significantly associated with increased adhesion likelihood (OR = 2.80; 95% CI: 1.02–7.73, p=0.047). Adhesion severity showed strongcorrelations with increased operative time (r=0.993, p<0.001) and estimated blood loss (r=0.995, p<0.001). Regression analysis indicated that the number of previous cesarean sections significantly influenced adhesion formation (p=0.011), whereas age and BMI were not significant predictors.
Conclusions: Depressed cesarean scars are reliable, visually assessable predictors of intra-abdominal adhesions, highlighting their potential role in preoperative risk stratification and surgical planning.