Rectus muscle and visceral peritoneum closure at cesarean delivery and intraabdominal adhesions

Deirdre J. Lyell, Aaron B. Caughey, Emily Hu, Yair Blumenfeld, Yasser Y. El-Sayed, Kay Daniels

Research output: Contribution to journalArticle

12 Scopus citations


OBJECTIVE: The purpose of this study was to evaluate the effect of the rectus muscle and visceral peritoneum closure at cesarean delivery on adhesions. STUDY DESIGN: We performed a secondary analysis of a prospective cohort study of women who underwent first repeat cesarean delivery. Surgeons scored the severity and location of adhesions. Records were abstracted to assess previous surgical techniques. RESULTS: The original cohort included 173 patients. Rectus muscle closure was associated with fewer combined filmy and dense adhesions overall (27.5% vs 46%; P =.04) and fewer dense adhesions overall (17.5% vs 46%; P =.001; adjusted odds ratio, [aOR], 0.24; 95% confidence interval [CI], 0.09-0.65), particularly from fascia to omentum (aOR, 0.08; 95% CI, 0.007-0.82). Visceral peritoneum closure was associated with increased dense fascia-to-omentum adhesions (aOR, 15.78; 95% CI, 1.81-137.24). CONCLUSION: Closure of the rectus muscles at cesarean delivery may reduce adhesions, and visceral peritoneum closure may increase them. Surgical techniques at cesarean delivery should be assessed independently, because they may have opposite effects on adhesion formation.

Original languageEnglish (US)
Pages (from-to)515.e1-515.e5
JournalAmerican journal of obstetrics and gynecology
Issue number6
StatePublished - Jun 2012



  • adhesion
  • cesarean delivery
  • rectus muscle
  • visceral peritoneum

ASJC Scopus subject areas

  • Obstetrics and Gynecology

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