Postcesarean delivery adhesions associated with delayed delivery of infant.

OBJECTIVE The purpose of this study was to estimate the incidence of adhesions after cesarean deliveries and to determine their impact on delivery and infant well-being. STUDY DESIGN This was a retrospective cohort analysis with chart review. The charts of 542 women who had undergone primary (265 women) or repeat cesarean (277 women) deliveries were reviewed. The incidence, severity, and locations of adhesions; delivery time; cord blood pH, and Apgar scores were noted. RESULTS After the first cesarean delivery, 100 of 217 women (46%) had pelvic adhesive disease; 48 of 64 women (75%) who underwent a third cesarean delivery and 5 of 6 women (83%) who underwent a fourth cesarean delivery had formed pelvic adhesive disease. Compared with primary cesarean section, delivery of the infant was delayed 5.6 minutes (52%) with 1 previous cesarean birth, 8.5 minutes (79%) after 2 cesarean birth, and 18.1 (169%) during the fourth cesarean birth (P < 0.001 for all comparisons). CONCLUSION A high percentage of cesarean deliveries result in adhesive disease, which delays repeat cesarean delivery of the fetus. The potential for adhesive disease should be included in counseling regarding primary elective cesarean births.