POST-CESAREAN ADHESIONS AND INTERPREGNANCY INTERVAL: IMPLICATIONS FOR LONG-TERM MATERNAL HEALTH IN MIDLIFE

Abstract

Background: Cesarean sections (CS) are increasingly common worldwide. A significant complication is intra-abdominal adhesion formation, which can lead to long-term morbidities such as chronic pelvic pain, infertility, and bowel obstruction, potentially impacting women's health well into midlife. The interpregnancy interval (IPI) may influence adhesion severity.
Aims: To investigate the correlation between the degree of intra-abdominal adhesions and IPI in women undergoing repeat CS, and to explore the potential implications for long-term maternal health, particularly concerning conditions that may manifest or persist into midlife.
Methods: This prospective observational study was conducted at a tertiary care center from 2022-2024. A total of 253 women with one prior CS, gestational age ≥37 weeks, and no other major abdominal surgeries were included. Intra-abdominal adhesions were assessed intraoperatively using the standardized C.G Adhesion Scoring System. Data on IPI, maternal demographics, intraoperative findings, and complications were collected. Statistical analysis involved Chi-square tests, ANOVA, and correlation coefficients.
Results: Adhesions were present in 63.6% of participants, with dense adhesions in 42.7%. A highly significant correlation was found between IPI and adhesion severity (p < 0.001; Cramér’s V = 0.265). Women with an IPI of 19–59 months had the highest rate of dense adhesions (52.0%). Shorter IPIs (<18 months) were associated with more flimsy adhesions but also a higher incidence of thinned-out lower uterine segments (46.5%). Longer IPIs (≥60 months) showed a bimodal pattern with both high rates of no adhesions (55.0%) and high mean adhesion scores when present. Dense adhesions were significantly associated with increased incision-to-delivery time (p < 0.001) and greater intraoperative blood loss (p < 0.001).
Conclusion: The interpregnancy interval is a significant factor influencing the severity of post-cesarean adhesions. These adhesions contribute to immediate surgical morbidity and have the potential for long-term sequelae, such as chronic pain and organ dysfunction, which can impair quality of life during midlife. Optimal birth spacing and meticulous surgical techniques are crucial in mitigating these risks.