The Association between Body Mass Index and Intra-abdominal Adhesions in Women Undergoing Repeat Caesarean Sections

Abstract

Background: Obesity is a widely spread health problem, the complications of which are too many, whether general or obstetric. Methods: In this prospective observational study, 232 pregnant ladies were included. They were divided into two groups to compare the degree of intra-abdominal adhesions between women with BMI less than 30 kg/m2 (group 1) and those with BMI more than or equal to 30 kg/m2 (group 2). We also subdivided group 2 candidates into 3 subgroups to compare different degrees of adhesions among them: Group 2a: women with BMI between 30-35, Group 2b: women with BMI between 35-40 and Group 2c: women with BMI more than 40. BMI of pregnant women was calculated on admission; preoperative hemoglobin was measured for each patient, and the degree of adhesion intra-operative was observed according to Tulandi's classification of adhesions. Bladder & bowel injuries were recorded. Postoperative hemoglobin for each case was measured. Results: The current study showed an increased incidence of omental adhesions and adhesions between the uterus and abdominal fascia in group 2 more than group 1, but regarding adhesions between uterus & bladder and adhesions to other pelvic organs, the results were similar in both group. Women with BMI more than or equal to 30 kg/m2 are at higher risk of hemoglobin drop during CS compared to those with BMI less than 30 kg/m2. Bladder and bowel injuries were also similar in both groups. Conclusion: Women with BMI more than or equal to 03kg/m2 tend to have a higher incidence of omental adhesions and adhesions between the uterus and abdominal fascia than those with BMI less than 30kg/m2. Women with BMI more than or equal to 30 kg/m2 are at higher risk of hemoglobin drop during CS compared to those with BMI less than 30 kg/m2.