Evidence Library · The uterus itself

Scar tissue inside the abdomen

Adhesions make every later operation longer and riskier.

Adhesions are internal scars that glue organs together. On ultrasound examination of 308 women with a history of cesarean, pelvic adhesions were seen in 45.1% and adhesions in the space in front of the uterus in 25.6%. Each additional cesarean raised the odds of adhesions in that space more than threefold.

In a prospective study of 335 scheduled cesareans, adhesions were present in 2.8% of women with no prior cesarean, 51% with one prior cesarean, and 62% with more than one. Adhesions added about 9.6 minutes to the operation, about 2.4 minutes to the time until the baby was out, and about 58 mL of extra blood loss when severe.

Adhesions are also associated with chronic pelvic pain, and they are the reason bladder and bowel injury rates climb with each repeat operation.

Where this comes from:

322. Moro F, Mavrelos D, Pateman K, Holland T, Hoo WL, Jurkovic D. Prevalence of pelvic adhesions on ultrasound examination in women with a history of Cesarean section. Ultrasound Obstet Gynecol. 2015;45(2):223-228.

323. Nuamah MA, Browne JL, Öry AV, Damale N, Klipstein-Grobusch K, Rijken MJ. Prevalence of adhesions and associated postoperative complications after cesarean section in Ghana: a prospective cohort study. Reprod Health. 2017;14(1):143.

Covered in the essential classes

Continue

More from Next pregnancy

This page is educational. It supports the conversation with your own clinicians. It is not consent to any treatment, and it cannot assess you. If you are worried about a symptom now, see urgent warning signs.