Clear Film Adhesion Barrier Use at Cesarean Section: A Retrospective Analysis

Objective: To evaluate the use of a carboxymethylcellulose-hyaluronate adhesion barrier (Seprafilm) at the time of Cesarean section. Design: Retrospective cohort study. Setting: A tertiary care center in Boston, MA, USA. Population: All women who underwent Cesarean section between the years 2006-2010 and returned for a second pelvic surgical procedure. Methods: All patients who had a Seprafilm barrier placed at the first (index) Cesarean section were matched on a 2:1 basis to those who had no barrier. Effectiveness and surgical outcomes were compared with Chi Square and Wilcoxon tests. Cofounders were identified and controlled with logistic regression models. Main Outcome Measures: The location and severity of pelvic adhesions at the follow-up pelvic surgery. Results: Seventy-seven women who had Seprafilm placed at the index delivery were matched to 154 controls who received no barrier. The two groups had similar rates of any dense adhesions (43% and 42% respectively, p=.78) and those on the anterior uterus (34% and 31%, p=.62) at follow-up surgery. After controlling for all significant confounders, barrier use did not show a significant decrease in any (aOR=0.79, 95% CI 0.43-1.45) or anterior uterine dense adhesion formation (aOR=0.88, 95% CI 0.46-1.65). There were no significant differences in delivery times at follow-up (median 11 minutes in each group, p=.54), or in pelvic infection rate at the index surgery (5% in each group, p=1.0). Conclusion: Seprafilm use at Cesarean section was not associated with a significant decrease in dense adhesion formation.