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

Abstract

BACKGROUND 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. METHODS 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. RESULTS 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. CONCLUSION 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.

DOI: 10.1186/s12978-017-0388-0

Cite this paper

@inproceedings{Nuamah2017PrevalenceOA, title={Prevalence of adhesions and associated postoperative complications after cesarean section in Ghana: a prospective cohort study}, author={Mercy Anna Nuamah and Joyce L Browne and Alexander V. {\"{O}ry and Nelson K. R. Damale and Kerstin Klipstein-Grobusch and Marcus J Rijken}, booktitle={Reproductive health}, year={2017} }