Maternal morbidity at first repeat cesarean: a sub-analysis of Interceed™ barrier placed at primary cesarean section

Hector O Chapa, Gonzalo Venegas

Women's Specialty Center Dallas, Chapa Medical Consulting, Dallas, TX, USA

Objective: The aim of this study was to compare maternal morbidity at repeat cesarean section (CS) between use of a Gynecare Interceed™ Absorbable Adhesion Barrier (Gynecare, Somerville, NJ, USA) and non-use at primary cesarean delivery.
Design: This was a retrospective study of patients in whom an absorbable adhesion barrier was/was not used at their primary CS.
Methods: Mean and excessive blood loss, the need for adhesiolysis, and postoperative fever were compared between those in whom a barrier was used at first CS and those in whom a barrier was not used. Visceral injury at repeat cesarean was also compared between the two groups.
Results: No statistically significant difference in mean blood loss was noted between the two groups. However, significantly more patients in whom a barrier was not used had excessive intraoperative blood loss (barrier group, 1/53 [1.9%]; no-barrier group, 6/59 [10.1%]; P = 0.04). All seven cases of excessive blood loss had adhesiolysis. Significantly more patients in the no-barrier group underwent adhesiolysis (no-barrier group, 35/59 [59.3%]; barrier group, 7/53 [13.2%]; P = 0.03). No statistical difference in postoperative metritis was noted (1/59 [1.8%] in the barrier group and 1/59 [1.7%] in the no-barrier group; P = 0.99). Only one deserosalization of the bladder dome occurred in a patient in the no-barrier group.
Conclusion: Those in whom a barrier was not used at primary CS were more likely to have adhesiolysis and excessive blood loss (>1250 mL) at repeat CS. No significant difference in postoperative metritis/fever was noted between groups. Adhesion barrier at primary CS may reduce some aspects of maternal morbidity at repeat CS.

Keywords: excessive blood loss, adhesiolysis, postoperative metritis, postoperative fever, visceral injury