Difficulty in predicting intra‐abdominal adhesion before cesarean section: A case report

Clin Case Rep. 2022 Mar; 10(3): e05643.

Published online 2022 Mar 27. doi: 10.1002/ccr3.5643

,
¹
,
¹
,
¹
,
²
and
¹

Author information Article notes Copyright and License information Disclaimer

Data Availability Statement

Severe adhesions between the bladder and uterus necessitated an atypical incision in the cesarean section of a woman with endometriosis. This could not be predicted with pre‐surgery MRI. No methods in the literature are able to predict adhesions with true certainty; it is therefore still difficult to diagnose intra‐abdominal adhesions.

Keywords: adhesion, cesarean section, endometriosis, MRI

It is difficult to diagnose all conditions in the abdominal cavity by present medical procedure. We should consider the possibility of an unusual uterine incision in women with a history of endometriosis, adenomyosis, or severe dysmenorrhea.

The lower transverse incision is a basic surgical technique for cesarean sections, but other uterine incisions may be selected in certain cases, such as placenta previa and accreta. We present a case of fundal uterine incision delivery due to severe adhesions between the bladder and uterus caused by endometriosis. There is no description of such adhesion caused by endometriosis in the recent literature review regarding difficult cesarean sections by Visconti et al.
¹ Moreover, we could not find a report that clarifies the provided solutions to the difficulties of performing cesarean surgery in women with endometriosis; hence, we could not predict abdominal adhesions or uterine displacement by magnetic resonance imaging (MRI) before delivery. As a consequence, we searched for methods predicting intra‐abdominal adhesions preoperatively.

A 41‐year‐old nulliparous woman diagnosed with endometriosis during treatment for infertility was referred to our hospital at 13 weeks of gestation after in vitro fertilization (IVF) and frozen embryo transfer (FET). She was prescribed low‐dose estrogen progestin pills before the IVF‐FET. We suspected placenta previa based on transvaginal ultrasound findings at 24 weeks of gestation and diagnosed the patient with total placenta previa at 30 weeks of gestation by MRI (Figure ). Massive genital bleeding and uterine contractions appeared at 31 weeks of gestation. The patient was hospitalized and prescribed magnesium sulfate intravenously (1.0 g per hour) and antenatal corticosteroids (betamethasone 12 mg twice every 24 h) intramuscularly. The symptoms recurred 4 days later, and intravenously, ritodrine hydrochloride was administered. Since tocolysis was infeasible due to the side effects of the beta‐mimetic agent, including parotid gland swelling and elevated serum amylase (3074 U/L), we performed a cesarean section under spinal anesthesia.

Open in a separate window

(A) MRI image performed at 30 weeks of gestational age. (B) Position of the uterine walls during the operation. The bladder (shaded), anterior (crosses), fundus (horizontal stripes), and posterior (solid yellow) uterine walls are located at the front of the body

After a lower vertical abdominal incision, the right round ligament and oviduct were located in the center of the surgical field, and there were firm adhesions between the bladder and the anterior uterine wall. We made a midline vertical (classical) incision to avoid bladder injury, and a male infant weighing 1884 g was delivered in the cephalic position, with Apgar scores of 3 and 8. The infant was admitted to the Neonatal Intensive Care Unit (NICU) due to prematurity and low birth weight. The placenta was placed on the internal ostium of the uterus and was separated smoothly without massive bleeding. After the uterine suture, the incision was found to cross through the uterine fundus toward the posterior wall (Figure ). Consequently, the incision was similar to a transverse fundal uterine incision. We also found lesions of endometriosis, and adhesions between the posterior wall of the uterus and the sigmoid colon (Figure ). Anti‐adhesion agents were placed on the fundal uterine incision, and the abdominal wall was sutured. The estimated blood loss, including amniotic fluid during surgery, was 1605 ml, and the operation time was 56 min.

Open in a separate window

(A) Bladder is still firmly adhered to the anterior wall of the uterus after suturing of the uterine wound. A uterine incision extends toward the posterior wall of the uterus. (B) After the uterine suture, the incision (dotted line) crosses through the uterine fundus (solid line) toward the posterior wall. The round ligament (vertical stripe line) and oviduct (horizontal stripe lines) are located at the center, and the bladder (dotted pattern) is firmly adhered to the anterior uterine wall

Open in a separate window

Posterior wall of the uterus adheres to the sigmoid colon, and lesions of endometriosis are apparent (white triangle)

One day post‐surgery, the patient’s hemoglobin level was 9.2 g/dl; blood transfusion was therefore avoided. The mother was discharged 6 days after surgery. At 41 days postpartum, we found a hyperechoic lesion, representing the wound, located in the uterine fundus (Figure ). The baby was discharged from the NICU 60 days after birth, without any major complications.

Open in a separate window

Forty‐one days after surgery, transvaginal ultrasound shows the wound (white triangle) located around the fundal of the uterus (solid white line)

Since the placenta covered the internal uterine ostium in the MRI image at 30 weeks gestation, we diagnosed the patient with placenta previa (Figure ). The bladder, anterior, fundus, and posterior uterine walls were located toward the front of the body (Figure ). This situation was not predicted upon preoperative MRI. Intraoperative findings revealed that the uterus was displaced, and the bilateral round ligaments and oviducts were located in toward the front (Figure ). The adhesions between the bladder and uterus may have resulted from endometriosis. The patient demonstrated foci at the closed Douglas pouch during the operation (Figures  and ). Endometriosis was observed only by inspection and was not confirmed by pathological examination. However, the diagnosis was assumed to be correct because there was no history of pelvic inflammatory disease or abdominal surgery. The obstetricians and radiologists of the team retrospectively discussed the prenatal MRI during the postpartum period; however, they could not detect the round ligament or oviduct in the image because of the resolving limit. We investigated whether there were other methods available to diagnose unusual uterine positions.

3.1. Difficult cesarean sections

Visconti et al
¹. reviewed difficult cesarean sections. The article discussed “difficult” cesarean sections divided into four categories: difficult access to the lower uterine segment, complicated fetal extraction, laceration or organ damage, and abnormal placentation. The “difficult access” category included leiomyomas, obesity, and previous abdominal surgery, but not endometriosis. The article stated that the degree of adhesions created after abdominal surgery varies widely among individuals, making it impossible to predict. Therefore, if we are unable to distinguish between endometriosis and postoperative adhesions, adhesions caused by endometriosis are also considered difficult to predict. Previous studies have reported several methods that may predict intra‐abdominal adhesions.

3.2. Abdominal scar characteristics

There are several reports on whether differences in the color and shape of skin markers and striae gravidarum can predict intra‐abdominal adhesions in pregnant women who have had at least one prior surgery. Prospective comparative studies have reported that factors related to skin markers, such as scar color and length, are associated with intra‐abdominal adhesions.
²,
³,
⁴ In contrast, Taylan et al
⁵. denied the accuracy of predictions using these methods, and Jaafer et al
⁶. demonstrated that these markers are not clinically reliable.

3.3. Sliding sign

Reid et al. presented the “sliding sign” technique to predict a closed pouch of Douglas preoperatively.
⁷,
⁸ The technique using transvaginal ultrasonography is well known as a non‐invasive and effective approach for detecting endometriotic adhesions in the pouch of Douglas and deep infiltrating endometriosis. A negative “sliding sign” was noted when the anterior rectosigmoid colon or the anterior rectum was fixed to the posterior uterine fundus or retrocervix. Hudelist et al
⁹. also concurred with these findings and deemed them useful. Ichikawa et al
¹⁰. proposed a scoring system that allowed for an accurate prediction of pelvic adhesion status and may potentially be an indicator of postoperative adhesion and infertility.

However, all these examinations were performed in a non‐pregnant state; hence, it is doubtful whether they are useful for predicting adhesions of the anterior wall of the uterus in pregnant women, as in this case.

Baron et al
¹¹. examined the “sliding sign” of the uterus under the inner part of the fascia of the abdominal muscles during deep breathing in the third trimester. They reported that it was useful for predicting the presence or absence of intra‐abdominal adhesions. This method may be useful for this case; however, a report of 112 pregnant women in 2021 revealed low reproducibility of these results.
¹²

3.4. MRI

Some articles suggested that MRI cannot be used for definitive diagnosis or endometriosis staging.
¹³,
¹⁴ Therefore, laparoscopy remains the procedure of choice. MRI has a high sensitivity for the diagnosis of ovarian endometriosis, but it has poor results in the detection of other types of endometrioses, including intra‐abdominal adhesions. Randall et al. reported that the “sheargram,” cine‐MRI technique depicts the amount of sliding between the abdominal contents and the wall of the abdominal cavity during respiratory cycles,
¹⁵,
¹⁶ but the results have yet to be generalized.

In this case, MRI performed during pregnancy showed a raised bladder, but no intra‐abdominal adhesions. Therefore, we concluded that adhesions are difficult to predict using MRI alone. Since our patient also had adhesions in the pouch of Douglas, it may be possible that the “sliding sign” of the posterior fornix and adhesions between the abdominal wall and uterus could be detected. However, a large clinical study of the “sliding sign” technique does not exist and therefore should be a topic for future research.

3.5. Fundal uterine incision

Kotsuji et al. reported a case of transverse fundal uterine incision in 2004,
¹⁷ and a case series in 2014,
¹⁸ which showed that this procedure has the potential to avoid transection of the placenta, preventing heavy bleeding and catastrophic fetal blood loss. However, such a case is rare, and the actual risk of uterine rupture and placenta accreta in subsequent pregnancies is unknown. In our case, the anterior uterine wall adhered to the vesicouterine pouch. We cut open the uterine corpus to create a classical incision, while avoiding bladder damage; however, a transverse fundal uterine incision was made, which may result in an increased risk of uterine rupture and placenta accreta in subsequent pregnancies.

3.6. Endometriosis and pregnancy outcome

It has been demonstrated that women with a history of endometriosis have an increased risk of obstetric complications, such as placenta previa, preterm delivery, preterm premature rupture of membranes, and stillbirth and the severity of endometriosis may have an adverse impact on pregnancy outcomes.
¹⁹,
²⁰,
²¹ This case could be evaluated as stage IV in the revised American Society for Reproductive Medicine scoring system; the case has a high‐risk for obstetrical complications
²⁰ that may develop into placenta previa and preterm delivery. Firm adhesion caused an atypical uterine incision. Several methods for predicting intra‐abdominal adhesions before surgery have been reported, and it is necessary to use such procedures. However, it is difficult to diagnose all conditions in the abdominal cavity. Physicians should consider the possibility of an unusual uterine incision in women with a history of endometriosis, adenomyosis, or severe dysmenorrhea. It is also necessary to share information with the surgical team in charge and prepare for possible damage to the surrounding organs. Advances in and increased utilization of assisted reproductive technology has resulted in an increased rate of pregnancies with severe endometriosis, which means that unexpected complications can occur during prenatal and delivery periods.

We encountered a case where the anterior wall of the uterus adhered to the vesicouterine pouch, making it difficult to perform the usual lower uterine approach for a cesarean section; the baby had to be delivered through a fundal incision. It is difficult to diagnose all conditions in the abdominal cavity by present medical procedure; so, physicians should consider the possibility of an unusual uterine incision in women with a history of endometriosis, adenomyosis, or severe dysmenorrhea.

The authors have no potential conflict of interest to declare.

Yu Wakaki involved in the clinical care of the patient and contributed to the conception, drafting, review, and revision of the manuscript. Kaori Watanabe and Yukiko Kumasaka involved in the clinical care of the patient and contributed to the conception and drafting. Rika Suzuki involved in the clinical care of the patient and contributed to the conception, drafting, review, and revision of the manusucript.

Written informed consent was obtained from the patient for the publication of this work.

We would like to thank Editage (www.editage.com) for English language editing.

Suzuki N, Wakaki Y, Watanabe K, Kumasaka Y, Suzuki R. Difficulty in predicting intra‐abdominal adhesion before cesarean section: A case report. Clin Case Rep. 2022;10:e05643. doi: 10.1002/ccr3.5643
[CrossRef] [Google Scholar]

Funding information

This research did not receive any specific grant from funding agencies in the public, commercial, or not‐for‐profit sectors

Data sharing is not applicable to this article as no datasets were generated or analyzed during the current study.

1.
Visconti F, Quaresima P, Rania E, et al. Difficult caesarean section: a literature review. Eur J Obstet Gynecol Reprod Biol. 2020;246:72‐78. [PubMed] [Google Scholar]

2.
Dogan A, Ertas IE, Uyar I, et al. Preoperative association of abdominal striae gravidarum with intraabdominal adhesions in pregnant women with a history of previous cesarean section: a cross‐sectional study. Geburtshilfe Frauenheilkd. 2016;76(3):268‐272. [PMC free article] [PubMed] [Google Scholar]

3.
Çim N, Elçi E, Güneş Elçi G, Almalı N, Yıldızhan R. Are the skin scar characteristics and closure of the parietal peritoneum associated with pelvic adhesions?
Turk J Obstet Gynecol. 2018;15(1):28‐32. [PMC free article] [PubMed] [Google Scholar]

4.
Pergialiotis V, Frountzas M, Siotos C, Karampetsou N, Perrea DN, Efthymios VD. Cesarean wound scar characteristics for the prediction of pelvic adhesions: a meta‐analysis of observational studies. J Matern Fetal Neonatal Med. 2017;30(4):486‐491. [PubMed] [Google Scholar]

5.
Taylan E, Akdemir A, Ergenoglu AM, Yeniel AO, Tekindal MA. Can we predict the presence and severity of intra‐abdominal adhesions before cesarean delivery. Gynecol Obstet Invest. 2017;82(6):521‐526. [PubMed] [Google Scholar]

6.
Jaafar ZAA, Obeid RZ, Salman DA. Skin markers and the prediction of intraabdominal adhesion during second Cesarean delivery. Ginekol Pol. 2019;90(6):325‐330. [PubMed] [Google Scholar]

7.
Reid S, Lu C, Caiskar I, et al. Prediction of pouch of Douglas obliteration in women with suspected endometriosis using a new real‐time dynamic transvaginal ultrasound technique: the sliding sign. Ultrasound Obstet Gynecol. 2013;41:685‐691. [PubMed] [Google Scholar]

8.
Reid S, Lu C, Caiskar I, et al. The prediction of pouch of Douglas obliteration using offline analysis of the transvaginal ultrasound ‘sliding sign’ technique: inter‐ and intra‐observer reproducibility. Hum Reprod. 2013;28(5):1237‐1246. [PubMed] [Google Scholar]

9.
Hundelist G, Fritzer N, Staettner S, et al. Uterine sliding sign: a simple sonographic predictor for presence of deep infiltrating endometriosis of the rectum. Ultrasound Obstet Gynecol. 2013;41(6):692‐695. [PubMed] [Google Scholar]

10.
Ichikawa M, Akira S, Kaseki H, et al. Accuracy and clinical value of an adhesion scoring system: a preoperative diagnostic method using transvaginal ultrasonography for endometriotic adhesion. J Obstet Gynaecol Res. 2020;46(3):466‐478. [PubMed] [Google Scholar]

11.
Baron J, Tirosh D, Mastrolia SA, et al. Sliding sign in third‐trimester sonographic evaluation of intra‐abdominal adhesions in women undergoing repeat cesarean section: a novel technique. Ultrasound Obstet Gynecol. 2018;52(5):662‐665. [PubMed] [Google Scholar]

12.
Shu W. Predicting intra‐abdominal adhesions for repeat cesarean delivery with the ultrasound sliding sign. J Obstet Gynaecol Can. 2021;43(11):1274‐1278. [PubMed] [Google Scholar]

13.
Zawin M, McCarthy S, Scoutt L, Comite F. Endometriosis: appearance and detection at MR imaging. Radiology. 1989;171(3):693‐696. [PubMed] [Google Scholar]

14.
Arrivé L, Hricak H, Martin MC. Pelvic endometriosis: MR imaging. Radiology. 1989;171(3):687‐692. [PubMed] [Google Scholar]

15.
Randall D, Fenner J, Gillott R, et al. A novel diagnostic aid for detection of intra‐abdominal adhesions to the anterior abdominal wall using dynamic magnetic resonance imaging. Gastroenterol Res Pract. 2016;2016:2523768. [PMC free article] [PubMed] [Google Scholar]

16.
Randall D, Joosten F, Ten Broek RP, et al. A novel diagnostic aid for intra‐abdominal adhesion detection in cine‐MRI: pilot study and initial diagnostic impressions. Br J Radiol. 2017;90(1077):20170158. [PMC free article] [PubMed] [Google Scholar]

17.
Sunkunami K, Hattori K, Nishijima K, Kotsuji F. Transverse fundal uterine incision in a patient with placenta increra. J Matern Fetal Neonatal Med. 2004;16(6):355‐356. [PubMed] [Google Scholar]

18.
Kotsuji F, Nishijima K, Kurokawa T, et al. Transverse uterine fundal incision for placenta praevia with accreta, involving the entire anterior uterine wall: a case series. BJOG. 2013;120(9):1144‐1149. [PubMed] [Google Scholar]

19.
Farland LV, Prescott J, Sasamoto N, et al. Endometriosis and risk of adverse pregnancy outcomes. Obstet Gynecol. 2019;134(3):527‐536. [PMC free article] [PubMed] [Google Scholar]

20.
Fujii T, Wada‐Hiraike O, Nagamatsu T, et al. Assisted reproductive technology pregnancy complications are significantly associated with endometriosis severity before conception: a retrospective cohort study. Reprod Biol Endocrinol. 2016;14(1):73. [PMC free article] [PubMed] [Google Scholar]

21.
Harada T, Taniguchi F, Amano H, et al. Adverse obstetrical outcomes for women with endometriosis and adenomyosis: a large cohort of the Japan environment and children’s study. PLoS One. 2019;14(8):e0220256. [PMC free article] [PubMed] [Google Scholar]

C-Section Scar Endometriosis – Seckin Endometriosis Center

Home » C-Section Scar Endometriosis

In this Article

• C-section scar endometriosis prevalence
• C-section scar endometriosis causes
• C-section scar endometriosis symptoms
• Diagnosis
• Treatment
• Patient story 

C-Section Scar Endometriosis

Endometriosis lesions most commonly appear in the peritoneum, and in the ovaries, bladder, and bowels. More rarely, endometriosis can also develop in the incision site of a Cesarean section (C-section). This is called C-section scar endometriosis.

C-section scar endometriosis prevalence

Due to its varying clinical presentation and overall rareness, there are currently no concrete data on the prevalence of this type of endometriosis. The literature reports an incidence of 0.03% to 0.8%. 

The increasing number of C-section procedures means that there is also an increase in the prevalence of C-section scar endometriosis.

C-section scar endometriosis causes

The exact way in which a C-section can cause endometriosis is not clear. Factors, such as hormones or wound environment may contribute to the development of this type of endometriosis. 

Ready for a Consultation?

Our endometriosis specialists are dedicated to providing patients with expert care. Whether you have been diagnosed or are looking to find a doctor, they are ready to help.

Our office is located on 872 Fifth Avenue New York, NY 10065.

You may call us at (212) 988-1444 or have your case reviewed by clicking here.

Review My Case

C-section scar endometriosis symptoms

As with other types of endometriosis, the most common symptom of C-section scar endometriosis is pelvic pain, which is often cyclical in nature. However, non-cyclical pain may also occur. 

Another common symptom is the development of a mass or lump in or adjacent to the C-section scar. The contamination of the wound with endometrial tissue or pre-existing intraperitoneal endometriosis likely causes the development of this mass. 

Symptoms may often take months or years to become apparent following a C-section.

Diagnosis

Patients often face misdiagnosis or delayed diagnosis in case of C-section scar endometriosis as with other types of endometriosis. 

The most reliable method for diagnosing this type of endometriosis is excisional biopsy. Here, the surgeon takes out a sample during surgery and sends it to a specialist who analyses it to identify any endometrial cells.

Imaging techniques such as computerized tomography (CT) and magnetic resonance imaging (MRI) scan can also be used. However, these are non-specific and are useful mostly used to exclude alternative diagnoses of abdominal wall masses, such as tumors or hernias. 

Treatment

The treatment and management of C-section scar endometriosis depend on several factors. 

Doctors may choose medical treatments, surgery, or a combination of both. Medical treatment may involve painkillers and hormonal treatments such as combined oral contraceptives. 

Surgery with wide local excision with at least 1 cm margins is the gold standard treatment. This can help prevent the recurrence and malignant transformation of the disease.

Patient story 

Read Natina’s story for whom a routine C-section caused her to have stage 4 endometriosis after more than a decade and Dr. Seckin’s approach that finally healed her.

Ready for a Consultation?

Our endometriosis specialists are dedicated to providing patients with expert care. Whether you have been diagnosed or are looking to find a doctor, they are ready to help.

Our office is located on 872 Fifth Avenue New York, NY 10065.
You may call us at (646) 960-3080 or have your case reviewed by clicking here.

Review My Case

symptoms, causes, diagnosis, prevention and treatment

• Medical Center

• Directory of Diseases

• Adhesions in the pelvis

Human internal organs are covered with slippery shells, which allows them to move relative to each other. The adhesive process in the pelvic area leads to the fact that the organs lose their normal mobility, which provokes deviations in their work.

Contents

• What are peritoneal adhesions
• Causes of adhesions
• Classification of adhesions in the pelvis
• Symptoms of the adhesive process
• Treatment of adhesive disease

9000 9 Rehabilitation after adhesion surgery

• Prevention of adhesions

What are peritoneal adhesions

Pelvic adhesions are connective tissue bands that cover the surfaces of the pelvic organs and connect them to each other and/or to the inner lining of the peritoneum. Pathologies are inherent in pain in the pelvic region, abnormalities in the work of the intestines, and sometimes infertility and miscarriage.

Adhesive disease is called “plastic pelvioperitonitis”. In most cases, it occurs in women of childbearing age, is considered one of the most common causes of chronic pelvic pain and can cause acute intestinal obstruction. In men, the disease is rare.

Causes of adhesions

Adhesions are formed against the background of conditions that stimulate the active formation of connective tissue. The causes of the adhesive process are as follows:

1. Inflammation in the pelvic area. Adhesions are often diagnosed in women who have had inflammation, diagnosed with chronic inflammation of the uterine appendages, chronic endometritis, and so on.
2. Operations, especially multiple ones. The risk of adhesion formation becomes higher after laparotomy operations, such as removal of the appendix or caesarean section.
3. Hemorrhages in the pelvic area. Adhesions may appear due to ovarian apoplexy. Another development of the pathology is a rupture of the fallopian tube during an ectopic pregnancy.
4. Endometriosis. Adhesions may occur with or without surgery for endometriosis. In the latter case, they appear against the background of local inflammation due to the reaction of the immune system to the focus of endometriosis, as well as as a result of local hemorrhages due to the formation of endometrioid cysts.
5. Injuries of the pelvic area. Injuries to the pelvic region resulting from an accident or for other reasons lead to adhesions.

According to statistics, in more than 50% of cases, adhesions appear in the presence of at least 2 reasons. Factors that increase the risk of developing pathology are: gynecological diseases, late treatment, promiscuity.

Classification of adhesions in the small pelvis

Classification of pathology is carried out according to the stages of its course:

1. Acute. There is a clear clinical symptomatology, which is expressed in pain, fever, lowering blood pressure, nausea and other manifestations of intoxication. Sometimes there is intestinal obstruction.
2. Intermittent. The adhesive process is characterized by periods of exacerbations and remissions. During exacerbations, pain appears, there may be disturbances in the work of the intestines. In remission, there are no symptoms or they are minimal.
3. Chronic. Pathology proceeds without a clinical picture or with implicit manifestations. A woman may have constipation and pain in the lower abdomen. Typically, patients turn to a gynecologist because they cannot become pregnant.

Adhesion symptoms

If the disease is not complicated by other conditions, then its main manifestation is pain syndrome. A woman almost always feels a dull or aching pain of varying severity in the lower abdomen during physical activity, nervous experiences, hypothermia, menstrual bleeding and ovulation. Soreness can be with a bowel movement, intense intercourse, an overly full bladder, or immediately after urination.

If the adhesions press on the pelvic organs, they begin to malfunction. First of all, there are violations of the intestines: constipation, bloating, frequent stools. Sometimes nausea bothers. Vomiting is rare. Gastrointestinal symptoms become stronger after eating foods that provoke increased flatulence. If the fallopian tubes and ovaries are affected, then the woman may have difficulty conceiving.

Diagnosis of adhesive disease

At the initial appointment, the doctor interviews the patient. Next, he conducts an examination in the gynecological chair, in which he performs bimanual palpation, which suggests the presence of adhesions. For a more reliable diagnosis of pathology, perform:

1. Diagnostic laparoscopy. It allows you to see adhesions between the pelvic organs.
2. Ultrasound examination of the pelvic organs. As a result of the examination, adhesions are found that connect the pelvic organs with the walls of the small pelvis.
3. HSG and ultrasonic HSG. These methods allow you to assess whether the fallopian tubes are involved in the adhesive process.
4. MRI of the pelvic organs. It allows you to see adhesions in the pelvic region in three dimensions.

To find out the causes of the disease, the gynecologist may order laboratory tests for the woman, for example, taking a swab for microflora, STIs.

Treatment of adhesive disease

The doctor chooses the treatment based on the course, stage of the pathology and the severity of its manifestations. At the initial stage of the disease, treatment includes:

1. Antibiotics if the adhesive has been caused by an infection.
2. NSAIDs. They are used to relieve pain, relieve swelling and resolve adhesions.
3. Hormonal drugs. They are necessary for adhesions that have appeared due to extragenital or genital endometriosis.
4. Fibrinolytic agents. Their use helps to partially or completely achieve the resorption of adhesions.
5. Physiotherapy. It is considered as an additional method of treatment. Balneotherapy can also be used.

If conservative therapy is ineffective, the adhesive process proceeds in an acute or intercurrent form, then surgery is performed (usually endoscopically).

Rehabilitation after adhesion surgery

After the operation, the woman stays in the hospital for 2-10 days (depending on her state of health and the characteristics of the intervention). Dressings are done every three days, the stitches are removed after a week.

During the rehabilitation period, the following should be excluded for half a month:

• swimming in open water;
• sexual acts;
• excessive emotional and physical stress;
• visit to the bathhouse.

Patients may be given antibiotics to prevent infection.

Prevention of adhesions

To prevent the disease, you need to regularly undergo scheduled examinations by a gynecologist to identify and treat inflammation, refuse unjustified invasive operations, plan a pregnancy, and also use barrier methods of contraception (condoms) during sexual intercourse with casual partners.

If surgery is required to reduce the risk of adhesions, the most gentle type of surgery should be chosen. Complications after surgery should be treated in time, and during the rehabilitation period, adhere to the motor regimen.

Adhesions in the pelvis can not only manifest as pain, but also lead to infertility. Therefore, when the first symptoms of pathology are detected, you should consult a doctor. In the early stages, it responds well to therapy, which avoids the development of complications, including acute intestinal obstruction.

In the rehabilitation clinic in Khamovniki, you can get a consultation from a specialist, as well as be examined using high-precision equipment. We have a physiotherapy room where you can undergo physiotherapy in comfortable conditions with benefits for your health.

LLC “Business Center ARBAT” does not participate in the implementation of the Program of State Guarantees and the Territorial Program of State Guarantees of free provision of medical care to citizens.

The materials posted on this site are for informational purposes and are intended for informational purposes only, they are not medical recommendations. Diagnosis and choice of treatment tactics is the prerogative of your doctor. OOO “Business Center ARBAT” is not responsible for the negative consequences resulting from the use of information posted on the website www.mos-clinics.ru

The price information indicated on the site is not a public offer. Check the cost of services with the administrators of the clinic.

To contact the Chief Physician, leave your message at [email protected]

there are contraindications. specialist advice is needed

Adhesions after cesarean section: symptoms, treatment, prevention

Adhesions after cesarean section: symptoms, treatment, prevention

Content:

• Essence of disease
• Symptoms
• Diagnostics
• Treatment
• Prophylaxis
• Complications

Often, a young mother who has just given birth is diagnosed with adhesions after a caesarean section, which can seriously harm her health. So that they do not cause complications, timely intervention of a specialist is required. After the examination, he prescribes a course of treatment, which is determined by the degree of neglect and the scale of the adhesive process.

Most often, unpleasant consequences can be avoided, and nothing prevents the mother from enjoying communication with the baby. From the first days of his birth, she must be on the alert, know that this is possible and pay attention to the slightest deviations in her condition and well-being.

Contents:

• Essence of the disease
• Symptoms
  • Small pelvis: symptoms of adhesions
  • Abdominal cavity: adhesions
• Diagnostics
• Treatment
  • Conservative treatment
  • Surgical methods
  • Folk remedies
• Prevention
• Complications

Nature of the disease 9 0033

First of all, a young mother should imagine what adhesions are and why they form after a cesarean. This will allow her to avoid panic and be able to prevent complications and undesirable consequences of the growing process.

According to doctors, adhesions are a natural protective reaction of the organism that has undergone surgery. The tissues damaged by the incision on the wall of the uterus are independently restored by scarring, since the skin is pulled together. In some cases, this occurs not only on the wounded organ, but also in nearby places that were somehow affected during surgery.

In particular, after caesarean delivery, adhesions in the pelvis (very common) or abdominal cavity (less often) are often diagnosed. Bowel loops can “stick together”, for example. It disrupts the functioning of internal organs and requires treatment.

Unfortunately, not all women are warned about this complication and often do not pay attention to the symptoms, which are a direct signal of distress. Drawing, constant pain in the back, lower abdomen, as well as problems with the stomach, are perceived by many as the norm after surgery and childbirth. In fact, this is exactly how the adhesive process manifests itself after a cesarean section, the signs of which it is desirable to catch as early as possible.

Paradox . On the one hand, adhesions are the body’s response to natural, self-protection against infections. On the other hand, such a good deed eventually turns into serious complications that require medical intervention and treatment.

Symptoms

If you at least approximately know the symptoms of adhesions after caesarean section, it is quite possible to catch the disease at the initial stage and prevent it from developing. This will save you from many complications in the future. Typical signs of an adhesive process that has begun largely depend on which organs it affected.

Small pelvis: symptoms of adhesions

1. Acute form

• pain syndrome;
• nausea;
• fever;
• increased heart rate;
• on palpation there is a sharp pain;
• intestinal obstruction;
• lowering blood pressure;
• drowsiness, weakness.

2. Intermittent form

• periodic pain;
• digestive disorders: constipation, diarrhea;
• changes in the menstrual cycle.

3. Chronic form

• rare but periodic pain.

Abdominal cavity: adhesive process

• constant pain;
• intestinal obstruction;
• abdominal cramps;
• vomiting;
• constipation;
• belching;
• flatulence.

The difficulty is that women perceive the first symptoms of adhesions as natural consequences of childbirth and caesarean section, endure them, try to cope with the same pain syndromes with home, familiar means. At this time, in the absence of proper treatment, the “gluing” of organs occurs more and more intensively. Moreover, the medical diagnosis of the disease is often also quite difficult and even completely accidental.

Be aware! Despite the fact that the symptoms of a chronic adhesive process that has affected the small pelvis are often hidden and do not prevent a woman from enjoying life, it is this form of the disease that is difficult to diagnose and treat, and also leads to infertility in 90% of cases.

Diagnosis

The problem is that adhesions after caesarean section are not diagnosed in the usual ways (using tests, for example). Ultrasound and x-rays also do not always detect them. The diagnosis is often made quite by accident, if some kind of planned surgical intervention is performed. Only complaints of a young mother about symptoms, their connection with a recent CS, as well as computed tomography and diagnostic laparoscopy are informative.

This is interesting! The laparoscopy method is by far the most informative method of examination for the presence of adhesions.

Treatment

Even with the level of modern medicine, the treatment of adhesions after caesarean section is difficult. They have not yet developed such medicines that would completely eliminate the process of “gluing” organs to each other. Nevertheless, there are conservative and operative methods that reduce the number of adhesions and prevent the appearance of new ones.

Conservative treatment

• physiotherapeutic methods;
• ultrasound using enzymatic agents – chymotrypsin, lidase, trypsin;
• ozokerite applications;
• drug Longidaz.

Operative methods

• laparoscopy: destruction of adhesions by electrocoagulation.

Since conservative treatment in this case is not always effective, and not everyone agrees to surgery after a recent operation, young mothers have to look for ways to treat adhesions after cesarean section at home.

Folk remedies

• Psyllium seeds

Pour 15 g of psyllium seeds into 200 ml of boiling water, boil for 7 minutes. After cooling and straining, drink 15 ml half an hour before a hearty meal, three times a day for 2 months.

• St. John’s wort

Pour 15 g of dried and chopped St. John’s wort with 200 ml of boiling water, boil. After straining, drink from adhesions after caesarean section, 50 ml (about a quarter cup) three times a day for 3 months.

• Boron Queen

Pour 75 g of crushed dry boron uterus into 500 ml (two glasses) of vodka. Infuse for half a month in the dark, shaking daily. Drink 40 drops immediately before a heavy meal.

By the way, the upland uterus can also be useful when planning a pregnancy, as we have already written about earlier.

• Aloe

Mix 15 g of finely chopped aloe leaves with 90 ml of honey and 90 ml of baked milk. Drink to dissolve adhesions twice a day for 2 months.

• Milk Thistle

Pour 15 g of milk thistle seeds with 200 ml of boiling water, boil for 15 minutes (approx.). After careful straining, drink hot daily for 1 month.

• Sabelnik

Pour 15 g of crushed cinquefoil into 200 ml (about a glass) of vodka. Insist 20 days. Drink from adhesions once a day, 30 ml for 45 days.

As practice shows, competent home treatment of adhesions after cesarean with folk remedies often brings results, resolves them. However, it is worth remembering that many herbs are too active in the lactation process and can adversely affect a baby who is breastfed. Therefore, before using them, be sure to consult your doctor. Of course, the most ideal option in this case is timely prevention, which it is advisable for expectant mothers to learn about before the operation.

Prevention

To avoid adhesions after caesarean section, it is enough to imagine the mechanism of their formation and interfere with it in every possible way. The process of “gluing” organs occurs more intensively when a young mother leads a sedentary, sedentary, or even recumbent lifestyle.

Indeed, after the operation, many people are afraid of scar dehiscence and therefore protect themselves from physical activity. This is the main mistake. Of course, you shouldn’t carry weights, but minor exercises, light household chores, walking daily walks – all this together are excellent preventive measures that will allow a woman to never know what it is.

Additionally, we recommend reading the article on proper recovery after caesarean section.

Complications

A young mother should know the dangers of adhesions in order to prevent possible consequences. After all, some of the complications of this disease can leave an imprint for the rest of your life. Especially for women, adhesive processes after cesarean, concerning the pelvic organs are fraught:

• violation of sexual life, which will only cause pain due to adhesions, but not pleasure;
• infertility.

Unrecognized and untreated adhesions in the peritoneum most often end in intestinal obstruction, the diagnosis of which will require you to go to the hospital and undergo a long and unpleasant course of treatment.

A young mother who has undergone abdominal surgery should be aware that after a caesarean section, she may develop adhesions, which can lead to unpleasant consequences. To avoid them, it is recommended from the very first days to take preventive measures and be extremely attentive to the slightest deviations in your well-being.