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Aboshama RA, Taha OT, Abdel Halim HW, Elrehim EIA, Kamal SHM, ElSherbiny AM, Magdy HA, Albayadi E, Elsaid RE, Abdelghany AM, Anan MA, Abdelfattah LE. Prevalence and risk factor of postoperative adhesions following repeated cesarean section: A prospective cohort study. Int J Gynaecol Obstet 2023; 161:234-240. [PMID: 36200671 DOI: 10.1002/ijgo.14498] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Revised: 08/12/2022] [Accepted: 10/03/2022] [Indexed: 11/09/2022]
Abstract
OBJECTIVE To evaluate the prevalence of intraperitoneal adhesions after repeated cesarean delivery and its associated personal and surgical risk factors. METHODS This prospective cohort study was conducted at the delivery ward at Fayoum University Hospital from October 2020 to December 2021. Women were recruited according to predetermined inclusion and exclusion criteria. Eligible women were interviewed, and data were obtained for personal history, past surgical and obstetrical history, and data about the current delivery. Nair's scoring system was used to evaluate intraperitoneal adhesions. Postoperative data and complications were reported. RESULTS Three hundred women were recruited. Moderate to severe adhesions occurred in 186 patients (62%). These patients had a significantly prolonged hospital stay and were delivered by expert surgeons (P < 0.001 and P = 0.008, respectively). The adhesion score correlated positively with patients' age (P < 0.001), parity (P < 0.001), interpregnancy interval (P = 0.033), duration of hospital admission either previously or in the current delivery (P = 0.001 and P < 0.001), time to ambulation (P < 0.001), time to intestinal movement (P < 0.001), operative time (P < 0.001), and surgeons' age and experience (both P = 0.015). CONCLUSION Adhesions led to increased maternal morbidity. Multiple contributing factors were significantly related to adhesions with multiple cesarean deliveries.
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Affiliation(s)
| | - Omima T Taha
- Department of Obstetrics and Gynecology, Faculty of Medicine, Suez Canal University, Ismailia, Egypt
| | - Hala Waheed Abdel Halim
- Department of Obstetrics and Gynecology, Faculty of Medicine for Girls, Al-Azhar University, Cairo, Egypt
| | - Eman Ibrahim Abd Elrehim
- Department of Obstetrics and Gynecology, Damietta Faculty of Medicine, Al-Azhar University, Damietta, Egypt
| | | | | | - Hagar Abdelgawad Magdy
- Department of Obstetrics and Gynecology, Faculty of Medicine for Girls, Al-Azhar University, Cairo, Egypt
| | - Eslam Albayadi
- Department of Anesthesia, Faculty of Medicine, Suez Canal University, Ismailia, Egypt
| | - Rasha Ezzat Elsaid
- Department of Obstetrics and Gynecology, Faculty of Medicine for Girls, Al-Azhar University, Cairo, Egypt
| | - Amany Mohamed Abdelghany
- Department of Obstetrics and Gynecology, Faculty of Medicine, Zagazig University, Zagazig, Egypt
| | - Mohamed A Anan
- Department of Obstetrics and Gynecology, Faculty of Medicine, Aswan University, Aswan, Egypt
| | - Laila Ezzat Abdelfattah
- Department of Obstetrics and Gynecology, Faculty of Medicine, Fayoum University, Fayoum, Egypt
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Zhang W, Yuan Y, Yang Q. Analysis of the effects of different methods of cesarean section on abdominal wall adhesion and dyspepsia syndrome. Panminerva Med 2023; 65:110-112. [PMID: 35319172 DOI: 10.23736/s0031-0808.21.04564-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Wenjie Zhang
- Department of Obstetrics, Hubei Maternal and Child Health Care Hospital, Wuhan, China
| | - Yichong Yuan
- Department of Gynecology, Hubei Maternal and Child Health Care Hospital, Wuhan, China
| | - Qiong Yang
- Department of Obstetrics, Hubei Maternal and Child Health Care Hospital, Wuhan, China -
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Wang X, Xiang L, Peng Y, Dai Z, Hu Y, Pan X, Zhou X, Zhang H, Feng B. Gelatin/Polycaprolactone Electrospun Nanofibrous Membranes: The Effect of Composition and Physicochemical Properties on Postoperative Cardiac Adhesion. Front Bioeng Biotechnol 2021; 9:792893. [PMID: 34938724 PMCID: PMC8685426 DOI: 10.3389/fbioe.2021.792893] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Accepted: 11/08/2021] [Indexed: 11/13/2022] Open
Abstract
Cardiovascular diseases have become a major threat to human health. The adhesion formation is an inevitable pathophysiological event after cardiac surgery. We have previously shown that gelatin/polycaprolactone (GT/PCL, mass ratio 50:50) electrospun nanofibrous membranes have high potential in preventing postoperative cardiac adhesion, but the effect of GT:PCL composition on anti-adhesion efficacy was not investigated. Herein, nanofibrous membranes with different GT:PCL mass ratios of 0:100, 30:70, 50:50, and 70:30 were prepared via electrospinning. The 70:30 membrane failed to prevent postoperative cardiac adhesion, overly high GT contents significantly deteriorated the mechanical properties, which complicated the suturing during surgery and hardly maintained the structural integrity after implantation. Unexpectedly, the 0:100 membrane (no gelatin contained) could not effectively prevent either, since its large pore size allowed the penetration of numerous inflammatory cells to elicit a severe inflammatory response. Only the GT:PCL 50:50 membrane exhibited excellent mechanical properties, good biocompatibility and effective anti-cell penetration ability, which could serve as a physical barrier to prevent postoperative cardiac adhesion and might be suitable for other biomedical applications such as wound healing, guided tissue or bone regeneration.
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Affiliation(s)
- Xingang Wang
- Shanghai Institute of Pediatric Congenital Heart Disease, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai, China.,Children's Heart Center, Institute of Cardiovascular Development and Translational Medicine, The Second Affiliated Hospital and Yuying Children's Hospital, Wenzhou Medical University, Wenzhou, China
| | - Li Xiang
- Shanghai Institute of Pediatric Congenital Heart Disease, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Yongxuan Peng
- Department of Pediatric Cardiology, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Zihao Dai
- Children's Heart Center, Institute of Cardiovascular Development and Translational Medicine, The Second Affiliated Hospital and Yuying Children's Hospital, Wenzhou Medical University, Wenzhou, China
| | - Yuqing Hu
- Shanghai Institute of Pediatric Congenital Heart Disease, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Xiaoting Pan
- Children's Heart Center, Institute of Cardiovascular Development and Translational Medicine, The Second Affiliated Hospital and Yuying Children's Hospital, Wenzhou Medical University, Wenzhou, China
| | - Xingliang Zhou
- Shanghai Institute of Pediatric Congenital Heart Disease, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Hao Zhang
- Children's Heart Center, Institute of Cardiovascular Development and Translational Medicine, The Second Affiliated Hospital and Yuying Children's Hospital, Wenzhou Medical University, Wenzhou, China
| | - Bei Feng
- Shanghai Institute of Pediatric Congenital Heart Disease, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
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Post-Surgical Peritoneal Scarring and Key Molecular Mechanisms. Biomolecules 2021; 11:biom11050692. [PMID: 34063089 PMCID: PMC8147932 DOI: 10.3390/biom11050692] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Revised: 04/27/2021] [Accepted: 04/29/2021] [Indexed: 02/06/2023] Open
Abstract
Post-surgical adhesions are internal scar tissue and a major health and economic burden. Adhesions affect and involve the peritoneal lining of the abdominal cavity, which consists of a continuous mesothelial covering of the cavity wall and majority of internal organs. Our understanding of the full pathophysiology of adhesion formation is limited by the fact that the mechanisms regulating normal serosal repair and regeneration of the mesothelial layer are still being elucidated. Emerging evidence suggests that mesothelial cells do not simply form a passive barrier but perform a wide range of important regulatory functions including maintaining a healthy peritoneal homeostasis as well as orchestrating events leading to normal repair or pathological outcomes following injury. Here, we summarise recent advances in our understanding of serosal repair and adhesion formation with an emphasis on molecular mechanisms and novel gene expression signatures associated with these processes. We discuss changes in mesothelial biomolecular marker expression during peritoneal development, which may help, in part, to explain findings in adults from lineage tracing studies using experimental adhesion models. Lastly, we highlight examples of where local tissue specialisation may determine a particular response of peritoneal cells to injury.
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Perlman BE, Guerrero K, Karsalia R, Heller DS. Reproductive outcomes following a ruptured ectopic pregnancy. EUR J CONTRACEP REPR 2020; 25:206-208. [PMID: 32343158 DOI: 10.1080/13625187.2020.1755032] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Purpose: To determine the effect of ruptured ectopic pregnancies on the rate of future intrauterine pregnancies.Materials and Methods: This was a retrospective study of patients at a University-affiliated hospital with a history of an ectopic pregnancy between January 1991 to December 2016. All patients that underwent a salpingectomy for a tubal ectopic pregnancy were considered for this study. Intrauterine pregnancy rates for patients with a history of a ruptured ectopic pregnancy were compared to those with non-ruptured ectopic pregnancies. Fisher's exact test was used for analysis.Results: During the study period, 77 patients met the inclusion criteria. In this cohort, 14 patients with a history of a tubal ruptured ectopic pregnancy had achieved pregnancy within 12 months, compared to 24 patients in the non-ruptured group (52% vs 48%, p = 0.81). The rate of intrauterine pregnancies, compared to repeat ectopic pregnancy, in both the ruptured and non-ruptured group, was 71% (p > 0.99).Conclusion(s): Ruptured ectopic pregnancies did not adversely affect the rate of intrauterine pregnancy within 12 months of rupture when compared to non-ruptured ectopic pregnancies.
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Affiliation(s)
- Barry E Perlman
- Departments of Obstetrics, Gynecology and Women's Health, Rutgers-New Jersey Medical School, Newark NJ, USA
| | - Kerly Guerrero
- Departments of Obstetrics, Gynecology and Women's Health, Rutgers-New Jersey Medical School, Newark NJ, USA
| | - Ruchi Karsalia
- Departments of Obstetrics, Gynecology and Women's Health, Rutgers-New Jersey Medical School, Newark NJ, USA
| | - Debra S Heller
- Departments of Obstetrics, Gynecology and Women's Health, Rutgers-New Jersey Medical School, Newark NJ, USA.,Pathology, Immunology and Laboratory Medicine, New Jersey Medical School, Rutgers-New Jersey Medical School, Newark NJ, USA
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Watrowski R. Unifying local hemostasis and adhesion prevention during gynaecologic laparoscopies: experiences with a novel, plant-based agent. J OBSTET GYNAECOL 2019; 40:586-588. [PMID: 31480891 DOI: 10.1080/01443615.2019.1636779] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- Rafał Watrowski
- Department of Gynecology and Obstetrics, St. Josefskrankenhaus, Teaching Hospital of the University of Freiburg, Freiburg, Germany
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