Abdominal striae gravidarum in Preoperative prediction of severe intraperitoneal adhesions in women undergoing repeat caesarean section Mawande Mayibenye 1 , G.A.B Buga 1 , M.L. Mdaka 1 , Mirabel Nanjoh 2
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Abstract
Caesarean section is the most commonly performed procedure known to be associated with the development of intra-abdominal adhesions. These adhesions may lead to difficult repeat surgery and complications like haemorrhage, bladder and bowel injury. Determining which women are at risk for adhesions would help with triaging which women may have a risk for a complicated repeat surgery. The presence of abdominal striae gravidarum, among others has been proposed as one of the preoperative prediction tools for intraperitoneal adhesions. Design: This was a prospective observational study Setting: Nelson Mandela Academic Hospital, a tertiary hospital in the Eastern Cape region of South Africa between July 2021 and July 2022. Participants: 419 women with a previous caesarean section scar were approached in the third trimester and examined for severity of striae gravidarum. Methods: The severity of striae gravidarum was determined according to Davey’s scoring system. Intraperitoneal adhesions were evaluated according to the modified Nair scoring system. Three groups were established according to the severity of striae gravidarum, we assessed whether we could use this method to predict the presence of intraperitoneal adhesions at repeat caesarean section. Results: Between July 2021 and July 2022 we enrolled 419 women. Adhesions were present in 53.5%. Then 17.4% (N=73/419) had severe striae gravidarum, and 4.5% (N=19/419) had mild striae gravidarum. Women with dense adhesions were older, had more previous caesarean sections, longer incision-to-delivery time and more blood loss. The presence of mild/moderate striae gravidarum had a sensitivity of 27.23% and specificity of 84.10. The presence of severe striae gravidarum had a sensitivity of 21.4% and specificity of 87.2%. The presence of striae gravidarum in overall did not predict adhesions. Conclusions: Although the striae gravidarum has a low sensitivity in predicting dense intraperitoneal adhesions, it has an excellent specificity. The striae gravidarum can therefore be used by surgeons to identify patients who are unlikely to have dense intraperitoneal adhesions. This would be particularly useful in district hospitals for triaging patients with previous caesarean sections whom they can operate safely, while referring others to level 2 or 3 hospitals. The results cannot be generalized because there were very small number of patients with striae gravidarum. More studies are needed before the results can be applied to the general population.
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