Closure vs. nonclosure of the peritoneum at cesarean delivery

Objective: To compare the frequency and severity of celiac adhesions following cesarean sections performed with and without closure of the parietal and visceral peritoneum. Methods: A retrospective cohort study involved 612 women who underwent their second lower-segment transverse cesarean section. Results: Nonclosure of the parietal peritoneum at the time of the first cesarean section was associated with significantly more visceral adhesions than closure (16.2% vs. 8.1%; P=0.003), and closure of the visceral. peritoneum had a similar effect (16.1% vs. 6.7%; P=0.02). However, the difference in rates of severe adhesions was not statistically significant (12.9% vs. 17.6%; P=0.12). After controlling for confounding variables, it was found that closure of the parietat peritoneum reduced the rate of visceral adhesions 2.7-fold. Trial of labor before and fever after surgery increased the risk of severe adhesions 6.1-fold and 5.6 fold, respectively. Conclusion: Nonclosure of the peritoneum at primary cesarean section is associated with a significantly increased risk of visceral adhesions. (c) 2006 International Federation of Gynecology and Obstetrics. Published by Elsevier Ireland Ltd. All rights reserved.