Adhesion Assessment at First Repeat Caesarean Section With or Without Prior Adhesion Barrier Use.

Objective: To determine if placing a carboxymethylcellulose adhesion barrier material at the time of primary Caesarean section (CS) leads to a reduction in adhesive disease, clinical outcomes, and hospital costs encountered at the time of a first repeat CS.

Methods: We performed a prospective cohort study of women at a large community hospital undergoing a first repeat CS with available prior operative records. A rating scale assessing the location and severity of adhesions (range 0 = no adhesions to 3 = dense and/or vascular adhesions requiring electrocautery) at the time of repeat CS was utilized by obstetric residents blinded to previous adhesion barrier use.

Results: One hundred fourteen women met the criteria for the study and were enrolled; 34 women had been exposed to the carboxymethylcellulose adhesion barrier and 80 had not. Demographics and clinical factors were similar between groups. In women exposed and not exposed to the barrier, there were differences in mean ratings of adhesions between fascia and muscle (1.18 ± 1.00 vs. 1.67 ± 0.83, P = 0.012, Cohen's d = 0.53) and the overall adhesion rate (67.6% vs. 91.3%; P = 0.004); there were also differences in mean ratings of adhesions between the uterus and omentum (0.00 ± 0.00 vs. 0.19 ± 0.53, P = 0.032, Cohen's d = 0.51) and the overall adhesion rate (0% vs. 12.5%; P = 0.032). No differences between the groups in time from incision to delivery, operating time, blood loss, or hospital costs were noted at first repeat CS.

Conclusion: Use of a carboxymethylcellulose adhesion barrier is associated with a decrease in adhesions noted at the time of repeat CS. The limited clinical benefits observed do not support use of the material for prevention of adhesions after the first CS.