Prevalence of adhesions and associated postoperative complications after cesarean section in Ghana: a prospective cohort study

• Published in: Reproductive health 2017-11, Vol.14 (1), p.143-143, Article 143
• Main Authors: Nuamah, Mercy A, Browne, Joyce L, Öry, Alexander V, Damale, Nelson, Klipstein-Grobusch, Kerstin, Rijken, Marcus J
• Format: Article
• Language: English
• Subjects: Abdomen; Abdominal surgery; Adhesion; Adhesions; Adult; Age; Analysis; Cesarean section; Cesarean Section - adverse effects; Cesarean sections; Cohort analysis; Collaboration; Complications; Complications and side effects; Epidemiology; Female; Ghana - epidemiology; Health aspects; Health risk assessment; Humans; Low- and middle-income countries; Male; Obstetrics; Postoperative complications; Postoperative Complications - epidemiology; Pregnancy; Pregnancy complications; Prevalence; Prospective Studies; Reproductive health; Risk factors; Surgical techniques; Teaching hospitals; Tissue Adhesions - epidemiology; Tissue Adhesions - etiology; Ultrasonic imaging; Womens health
• ISSN: 1742-4755; 1742-4755
• DOI: 10.1186/s12978-017-0388-0

The global increase in Cesarean section rate is associated with short- and long-term complications, including adhesions with potential serious maternal and fetal consequences. This study investigated the prevalence of adhesions and association between adhesions and postoperative complications in a tertiary referral hospital in Accra, Ghana. In this prospective cohort study, 335 women scheduled for cesarean section at Korle-Bu Teaching Hospital in Accra, Ghana were included from June to December 2015. Presence or absence of adhesions was recorded and the severity of the adhesions was scored using a classification system. Associations between presence and severity of adhesions, postoperative complications, and maternal and infant outcomes at discharge and 6 weeks postpartum were assessed using multivariate logistic and linear regression analysis. Of the participating women, 128 (38%) had adhesions and 207 (62%) did not. Prevalence of adhesions increased with history of caesarean section; 2.8% with no CS but may have had an abdominal surgery, 51% with one previous CS, 62% with >1 CS). Adhesions significantly increased operation time (mean 39.2 (±15.1) minutes, absolute adjusted difference with presence of adhesions 9.6 min, 95%CI 6.4-12.8), infant delivery time (mean 5.4 (±4.8) minutes, adjusted difference 2.4 min, 95%CI 1.3-3.4), and blood loss for women with severe adhesions (mean blood loss 418.8 ml (±140.6), adjusted difference 57.6 ml (95%CI 12.1-103.0). No differences for other outcomes were observed. With cesarean section rates rising globally, intra-abdominal adhesions occur more frequently. Risks of adhesions and associated complications should be considered in counseling patients for cesarean section.