Fetomaternal Morbidity and Adhesions after Repeat Caesarean Section

Abstract

Background: Caesarean section (CS) is one of the most commonly performed obstetric procedures worldwide. With the increasing rate of repeat CS, postoperative adhesions have emerged as a major surgical challenge, potentially increasing maternal morbidity and affecting fetal outcomes. Understanding the extent and impact of adhesions can guide preventive strategies and improve surgical planning in obstetric practice. Objective: To assess the prevalence and severity of intra-abdominal adhesions and their association with fetomaternal morbidity in women undergoing repeat caesarean sections at a tertiary care hospital. Methodology: A cross-sectional study was conducted at the Department of Obstetrics and Gynaecology, Peoples University of Medical & Health Sciences for Women (PUMHS), Nawabshah for the duration of six months, from May 2024 to November 2024. Women undergoing repeat caesarean sections were enrolled after informed consent. Intraoperative findings were documented, including the presence, type, and extent of adhesions, using a standardized adhesion scoring system. Maternal outcomes such as surgical difficulty, blood loss, operative time, and intra/postoperative complications were recorded. Fetal outcomes including birth weight, Apgar score, and neonatal ICU admission were analyzed. Data were evaluated using SPSS, with statistical significance set at p < 0.05. Results: Among the studied women, a high prevalence of adhesions was observed, with dense adhesions in a significant proportion of repeat CS cases. Adhesions were strongly associated with prolonged operative time, increased intraoperative bleeding, and greater surgical difficulty. Fetomaternal morbidity, including wound infection, postpartum hemorrhage, and transient neonatal distress, was notably higher in women with severe adhesions. Conclusion: Adhesions after repeat caesarean sections contribute substantially to surgical and postoperative complications. Careful surgical technique, meticulous tissue handling, and the use of adhesion prevention measures can reduce future morbidity. Patient counseling regarding risks of repeat CS and promoting vaginal birth after caesarean (VBAC) where appropriate may help mitigate this growing concern.