Modern possibilities of prevention and diagnosis of adhesive disease in patients after caesarian section

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Abstract

This article discusses the relevance of adhesive disease after caesarian section due to the increase in the frequency of repeated operative delivery and the increasing risk of complications during both pregnancy and surgery.

The modern understanding of the pathogenesis of the adhesive process is highlighted in the article. It has been shown that in response to a peritoneal injury, a local inflammatory process is activated and local activation of the coagulation system occurs. In this case, the first few days of the postoperative period are extremely important, as mature fibrous adhesions are subsequently formed, and adhesion formation becomes irreversible.

The effectiveness of surgical, physiotherapeutic and drug-induced methods of treatment and prevention of the adhesion process is evaluated, and their insufficient effectiveness is shown. It is noted that the creation of a barrier between the contacting surfaces in the abdominal cavity is the optimal method for preventing spike formation. The methods of creating an anti-adhesion barrier proposed to date are considered.

The possibilities of non-invasive diagnostics of adhesive disease using ultrasound are shown, with the main ultrasound signs of abdominal adhesions considered. Preoperative ultrasound allows for assessing the risks of repeated surgical intervention and correctly determining the patient’s routing for delivery.

About the authors

Elena V. Mozgovaya

The Research Institute of Obstetrics, Gynecology and Reproductology named after D.O. Ott

Author for correspondence.
Email: elmozg@mail.ru
ORCID iD: 0000-0002-6460-6816
SPIN-code: 5622-5674

MD, Dr. Sci. (Medicine), Professor

Russian Federation, Saint Petersburg

Uliana M. Chuprun

The Research Institute of Obstetrics, Gynecology and Reproductology named after D.O. Ott

Email: ul_chuprun@mail.ru
ORCID iD: 0009-0009-4987-6840

MD

Russian Federation, Saint Petersburg

Ekaterina V. Kopteeva

The Research Institute of Obstetrics, Gynecology and Reproductology named after D.O. Ott

Email: ekaterina_kopteeva@bk.ru
ORCID iD: 0000-0002-9328-8909
SPIN-code: 9421-6407

MD, Cand. Sci. (Medicine)

Russian Federation, Saint Petersburg

Victoria S. Prokhorova

The Research Institute of Obstetrics, Gynecology and Reproductology named after D.O. Ott

Email: viprokhorova@yandex.ru
SPIN-code: 2450-7154

MD, Cand. Sci. (Medicine)

Russian Federation, Saint Petersburg

Olesya N. Bespalova

The Research Institute of Obstetrics, Gynecology and Reproductology named after D.O. Ott

Email: shiggerra@mail.ru
ORCID iD: 0000-0002-6542-5953
SPIN-code: 4732-8089

MD, Dr. Sci. (Medicine)

Russian Federation, Saint Petersburg

Sabinakhon S. Kholmatova

The Research Institute of Obstetrics, Gynecology and Reproductology named after D.O. Ott

Email: sabinakholmatova@icloud.com
ORCID iD: 0009-0006-3923-4156

MD

Russian Federation, Saint Petersburg

References

  1. Letter from the Ministry of Health of Russian Federation of 19 February 2019 No. 15-4/I/2–1286 “About sending a letter of guidance on the introduction of M. Robson’s classification of caesarean section operation”. [cited 2025 May 18] Available from: https://www.garant.ru/products/ipo/prime/doc/72123126/?ysclid=m3da7tvonf162926374 (In Russ.)
  2. Krasnopol’skaia KV, Popov AA, Chechneva MA, et al. Preconceptional methroplastic operation in patients with uterine scar incompetence after caesarian section: the influence on natural fertility and IVF outcomes. Russian Journal of Human Reproduction. 2015;21(3):56–62. EDN: UKSHHH doi: 10.17116/repro201521356-62
  3. Vogel JP, Betrán AP, Vindevoghel N, et al. Use of the Robson classification to assess caesarean section trends in 21 countries: a secondary analysis of two WHO multicountry surveys. Lancet Glob Health. 2015;3(5):e260–e270. doi: 10.1016/S2214-109X(15)70094-X
  4. Makiyan ZN, Adamyan LV, Karabach VV, et al. New method for surgical treatment of uterine scar insuffisiency after a previous cesarean section using an intrauterine manipulator with a groove. Obstetrics and Gynecology. 2020;(2):104–110. EDN: ZALQXA doi: 10.18565/aig.2020.2.104-110
  5. Arjaeva IA, Tyapkina DA, Taraskin AFZ, et al. Frequency of occurrence of the adhesive process of the abdominal cavity after cesarean section (according to the results of repeated surgery). International Research Journal. 2022;(3–1):102–108. EDN: UWPOOI doi: 10.23670/IRJ.2022.117.3.017
  6. Klykova ES, Novikova EI, Fomina IV. Adhesive process in abdominal cavity after caesarean section. Youth International Bulletin. 2019;8(2):137–139. (In Russ.)
  7. Chervonnaia IYu. Method of comprehensive therapy in reproductive function restoration in women with infertility during adenomyosis [dissertation abstract]. Volgograd; 2012. (In Russ.).
  8. Vlasova KS, Fomina IV. Characteristics of anamnesis, pregnancy and maternity in women with placenta percreta. Youth International Bulletin. 2018;7(1):104. (In Russ.)
  9. Burlev VA, Dubinskaia ED. Phenotypic characteristics of undifferentiated connective tissue dysplasia in patients with pelvic peritoneal adhesions. Russian Journal of Human Reproduction. 2012;18(2):8–14. EDN: PEKBTZ
  10. Bezhenar’ VF, Aĭlamazian ÉK, Baĭliuk EN, et al. The etiology, pathogenesis, and prevention of commissure formation during small pelvic surgery. Russian Bulletin of Obstetrician-Gynecologist. 2011;11(2):90–101. EDN: PZAVRV
  11. Fomina IV, Kukarskaya II, Schevlukova T, et al. Thromboelastometry in the obstetric hospital. Contemporary problems of science and education. 2017;(4):59. EDN: VZVDIT
  12. Fomina IV, Polyakowa VA. Modern methods research vascular – thrombocytic blood stasis (review). Medical science and education of the Urals. 2011;12(2):235–237. EDN: TEOXTZ
  13. Zakharov IS, Ushakova GA, Demyanova TN. et al. Adhesive disease of the pelvic organs: modern prevention opportunities. Consilium Medicum. 2016;18(6):71–73. EDN: XAMAYZ
  14. Dubinskaya ED, Gasparov AS, Nazarov SK, et al. Pelvic peritoneal patches (endoscopic characteristic). RUDN Journal of Medicine. 2010;(6):166–173. (In Russ.)
  15. Shalaev ON, Plaksina ND, Salimova LYa. Improvement of the effectiveness of reconstructive plastic surgery in young women with uterine prolepses. RUDN Journal of Medicine. 2008;(5):289–292. (In Russ.)
  16. Kistner RW. Peri-tubal and peri-ovarian adhesions subsequent to wedge resection of the ovaries. Fertil Steril. 1969;20(1):35–41. doi: 10.1016/s0015-0282(16)36902-3
  17. Fugazzola P, Coccolini F, Nita GE, et al. Validation of peritoneal adhesion index as a standardized classification to universalize peritoneal adhesions definition. Journal of Peritoneum. 2017;2:61. doi: 10.4081/joper.2017.61
  18. Nazarenko AA, Akimov VP. Laparoscopic adhesiolysis and prevention of abdominal adhesions by using mechanical barriers. Pirogov Russian Journal of Surgery. 2016;(8):83–85. EDN: WKENBT doi: 10.17116/hirurgia2016883-85
  19. Sulima AN, Puchkina GA. Efficacy of complex preventive approach to postoperative pelvic adhesios. Russian Journal of Woman and Child Health. 2021;4(2):130–136. EDN: LAZWYC doi: 10.32364/2618-8430-2021-4-2-130-136
  20. Hindocha A, Beere L, Dias S, et al. Adhesion prevention agents for gynaecological surgery: an overview of Cochrane reviews. Cochrane Database Syst Rev. 2015;1(1):CD011254. doi: 10.1002/14651858.CD011254.pub2
  21. Rodin A, Privolnev V, Shilina A. Prevention de adhesion formation in the abdomina cavity. Vrach. 2017;(10):6–10. (In Russ.) EDN: ZQQDNB
  22. Lysyakov NM. Influence of intraoperative hepatotherapy on the process of intra-abdominal adhesiogenesis during surgical interventions on the intestine [dissertation abstract]. Saransk; 2016. (In Russ.) EDN: ZQHABF
  23. Schindler AE. Gonadotropin-releasing hormone agonists for prevention of postoperative adhesions: an overview. Gynecol Endocrinol. 2004;19(1):51–55. doi: 10.1080/09513590410001725495
  24. Gudz’ OV, Sulima AN, Glazkov IS, et al. Anti-adhesion barriers in operative gynecology. Russian Journal of Woman and Child Health. 2024;7(2):144–149. EDN: ZYBAIQ doi: 10.32364/2618-8430-2024-7-2-9
  25. Gorskiĭ VA, Sivkov AS, Agapov MA, et al. The first experience of using a single-layer intra-abdominal collagen plate. Pirogov Russian Journal of Surgery. 2015;(5):59–61. EDN: UCAVJH doi: 10.17116/hirurgia2015559-61
  26. Kuznetsova MV, Kuznetsova MP, Afanasyevskaya EV, et al. Experimental grounds for using collagenbased anti-adhesion barrier coated with biocides for prevention of abdominal surgical infection. Modern Technologies in Medicine. 2018;10(2):66–75. EDN: XRVMST doi: 10.17691/stm2018.10.2.07
  27. Krishnan MA, Alimi OA, Kuss M, et al. A dual-layer hydrogel barrier integrating bio-adhesive and anti-adhesive properties prevents postoperative abdominal adhesions. Adv Healthc Mater. 2025;14(11):e2405238. EDN: BQYXIN doi: 10.1002/adhm.202405238
  28. Mitra SP. Protein adsorption on biomaterial surfaces: subsequent conformational and biological consequences – a review. J Surface Sci Technol. 2020;36(1–2):7–38. EDN: IWHHLM doi: 10.18311/jsst/2020/23282
  29. Nasyrova NI, Dobrokhotova YuE, Ozolinya LA, et al. Experience of anti-adhesion barrier in the complex therapy of patients with uterine factor infertility. Russian Journal of Woman and Child Health. 2023;6(4):326–331. EDN: DMWKTP doi: 10.32364/2618-8430-2023-6-4-1
  30. Meshkova OA, Bogdanov DYu, Matveev NL, et al. Application of modern antiadhesive agents in surgery. Endoscopic Surgery. 2015;21(3):37–42. EDN: VHUIWL doi: 10.17116/endoskop201521337-42
  31. Teo ZY, Senthilkumar SD, Srinivasan DK. Nanotechnology-based therapies for preventing post-surgical adhesions. Pharmaceutics. 2025;17(3):389. EDN: CYEACD doi: 10.3390/pharmaceutics17030389
  32. Hellebrekers BW, Trimbos-Kemper TC, Trimbos JB, et al. Use of fibrinolytic agents in the prevention of postoperative adhesion formation. Fertil Steril. 2000;74(2):203–212. doi: 10.1016/s0015-0282(00)00656-7
  33. Li J, Feng X, Liu B, et al. Polymer materials for prevention of postoperative adhesion. Acta Biomater. 2017;61:21–40. EDN: YJCETN doi: 10.1016/j.actbio.2017.08.002
  34. Kim T, Ahn KH, Choi DS, et al. A randomized, multi-center, clinical trial to assess the efficacy and safety of alginate carboxymethylcellulose hyaluronic acid compared to carboxymethylcellulose hyaluronic acid to prevent postoperative intrauterine adhesion. J Minim Invasive Gynecol. 2012;19(6):731–736. doi: 10.1016/j.jmig.2012.08.003
  35. Song J, Gerecht S. Hydrogels to recapture extracellular matrix cues that regulate vascularization. Arterioscler Thromb Vasc Biol. 2023;43(8):e291–e302. EDN: NGRTMR doi: 10.1161/ATVBAHA.122.318235
  36. Ahmad G, O’Flynn H, Hindocha A, et al. Barrier agents for adhesion prevention after gynaecological surgery. Cochrane Database Syst Rev. 2015;2015(4):CD000475. doi: 10.1002/14651858.CD000475.pub3
  37. Zindel J, Mittner J, Bayer J, et al. Intraperitoneal microbial contamination drives post-surgical peritoneal adhesions by mesothelial EGFR-signaling. Nat Commun. 2021;12(1):7316. EDN: ONRVID doi: 10.1038/s41467-021-27612-x
  38. DeWilde RL, Trew G. Postoperative abdominal adhesions and their prevention in gynaecological surgery. Expert consensus position. Part 2-steps to reduce adhesions. Gynecol Surg. 2007;4(4):243–253. doi: 10.1007/s10397-007-0333-2
  39. Filenko BP, Zemlyanoy VP, Kotkov PA. Treatment and recurrence prevention of acute adhesive intestinal obstruction. Herald of the Northwestern State Medical University named after I.I. Mechnikov. 2017;9(1):68–72. EDN: YLDZNX
  40. Zhao X, Yang J, Liu Y, et al. An injectable and antifouling self-fused supramolecular hydrogel for preventing postoperative and recurrent adhesions. Chem Eng J. 2021;404:127096. EDN: ZFYVKH doi: 10.1016/j.cej.2020.127096
  41. Molotkov AS, Popov EN, Ivanova AO, et al. Experience of the use of anti-adhesive barrier based sodium hyaluronate and carboxymethylcellulose in gynecological surgery. Medical Council. 2019;(13):149–153. EDN: WGLYYE doi: 10.21518/2079-701X-2019-13-149-153
  42. Golovkina NV, Krasnova IA. Echographic evaluation of the coagulation process before laparoscopy in patients with patients with laparotomy anamnesis. Modern science-intensive technologies.2004;(3):56–57. (In Russ.) EDN: IJMOKL
  43. Smereczyński A, Starzyńska T, Kołaczyk K, et al. Intra-abdominal adhesions in ultrasound. Part II: the morphology of changes. J Ultrason. 2013;13(52):93–103. doi: 10.15557/JoU.2013.0008
  44. Moro F, Mavrelos D, Pateman K, et al. Prevalence of pelvic adhesions on ultrasound examination in women with a history of Cesarean section. Ultrasound Obstet Gynecol. 2015;45(2):223–228. doi: 10.1002/uog.14628
  45. Armashov VP, Belousov AM, Vavshko MV, et al. Can we detect peritoneal adhesions with MRI and CT prior to abdominal surgery? Innovative Medicine of Kuban. 2023;8(1):97–102. EDN: CEHHRK doi: 10.35401/2541-9897-2023-26-1-97-102

Supplementary files

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2. Fig. 1. Pelvic adhesions. 2 months after a caesarean section. Bladder wall deformation.

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3. Fig. 2. Uterine niche. 2 months after a caesarean section.

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