The Relationship Between Striae Gravidarum And Intra-abdominal Adhesions In Pregnant Women With Previous Cesarean Section

Objective: The aim of this study was to evaluate whether there was an association between abdominal striae gravidarum and intra-abdominal adhesions in pregnant women with a history of cesarean section. Background: Intra-abdominal adhesions that develop because of prior abdominal or pelvic surgery may cause complications during surgery such as damage to the urinary bladder, uterus or small intestine; difficult intra-abdominal entry and hemorrhage. Methods: The study was a prospective observational study. Patients in the study were 210 pregnant patients with a history of at least one cesarean section divided into 3 groups: A (70 patients with no striae), B (70 patients with mild striae) and C (70 patients with severe striae). Preoperatively patient`s abdominal striae were assessed using the Davey score; the severity of adhesions were evaluated intrao-peratively using the modified Nair score. Result: No adhesions were found in 87 patients (grade 0), while 102 had grade 1–2 (filmy adhesions) and 21 had grade 3–4 (dense adhesions). Patients with no striae, there were no adhesions in 19 patients (21.8%), filmy adhesions in 36 patients (35.3%) and dense adhesions in 15 women (71.4%). Patients with mild striae, there were no adhesions in 27 patients (31.1%), filmy adhesions in 39 patients (38.2%) and dense adhesions in 4 patients (19.1%). Patients with severe striae, there were no adhesions in 41 women (47.1%), filmy adhesions in 27 patients (26.5%) and dense adhesions in 2 patients (9.5%). (sensitivity 81.2%; specificity 54.02 %; positive predictive value 67.14%; negative predictive value 67.14 %; Accuracy70%)(p value < 0.001). Conclusion: The adhesion score decreased significantly when the striae score was high (p < 0.0001) denoting statistically significant value with negative correlation.