{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,29]],"date-time":"2026-05-29T21:41:14Z","timestamp":1780090874089,"version":"3.54.0"},"reference-count":21,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2025,1,18]],"date-time":"2025-01-18T00:00:00Z","timestamp":1737158400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["obgyn.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Intl J Gynecology &amp; Obste"],"published-print":{"date-parts":[[2025,7]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Objective<\/jats:title><jats:p>The rising rates of cesarean delivery (CD), which are a leading cause of intra\u2010abdominal adhesions, represent a major concern for maternal health. We aimed to describe early maternal complications following CD in women with severe intra\u2010abdominal adhesions.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>A prospective observational study was conducted at a university\u2010affiliated tertiary medical center (January 2021 and March 2023) in Israel. Women who underwent CD were assessed for intra\u2010abdominal adhesions by questionnaires completed by the surgeons. Adhesions were evaluated at four anatomical sites: abdomen\u2010to\u2010uterus, uterus\u2010to\u2010bladder, skin\u2010to\u2010fascia, and other intra\u2010abdominal sites. Each site was scored on a scale of 0\u20132, with a total score ranging from 0 to 8. Severe adhesions were defined as a total score \u22655. The primary outcome measures were a composite complication which included at least one or more of postoperative need for blood or iron products, fever, prolonged hospitalization, re\u2010hospitalization, and emergency room visits.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Overall, 2797 women were included in the study, of whom 295 (10.6%) exhibited severe adhesions. Women with severe adhesions had a higher composite risk for maternal complications following CD (RR\u2009=\u20091.28, 95% confidence interval [CI]: 1.12\u20131.45, <jats:italic>P<\/jats:italic>\u2009&lt;\u20090.001), specifically, postoperative need for blood or iron products (RR\u2009=\u20091.71, 95% CI: 1.15\u20132.55, <jats:italic>P<\/jats:italic>\u2009=\u20090.007) and prolonged hospitalization (RR\u2009=\u20091.49, 95% CI: 1.10\u20132.03, <jats:italic>P<\/jats:italic>\u2009=\u20090.009). There were no significant group differences in the rates of postoperative fever, re\u2010hospitalization or emergency room visits. In multivariate analysis, severe adhesions had an independent impact on maternal complications (CI: 1.06\u20131.95, <jats:italic>P<\/jats:italic> value 0.017).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Severe intra\u2010abdominal adhesions diagnosed in CD had an impact on early maternal complications.<\/jats:p><\/jats:sec>","DOI":"10.1002\/ijgo.16161","type":"journal-article","created":{"date-parts":[[2025,1,18]],"date-time":"2025-01-18T09:25:24Z","timestamp":1737192324000},"page":"417-422","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Impact of severe intra\u2010abdominal adhesions on early maternal complications following cesarean delivery"],"prefix":"10.1002","volume":"170","author":[{"given":"Shai","family":"Ram","sequence":"first","affiliation":[{"name":"Lis Hospital for Women's Health Tel Aviv Sourasky Medical Center  Tel Aviv Israel"},{"name":"Faculty of Medicine Tel Aviv University  Tel Aviv Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hila","family":"Shalev\u2010Ram","sequence":"additional","affiliation":[{"name":"Faculty of Medicine Tel Aviv University  Tel Aviv Israel"},{"name":"Department of Obstetrics and Gynecology Meir Medical Center  Kfar Saba Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shira","family":"Alon","sequence":"additional","affiliation":[{"name":"Department of Statistics and Data Science Hebrew University of Jerusalem  Jerusalem Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shai","family":"Trigerman","sequence":"additional","affiliation":[{"name":"Lis Hospital for Women's Health Tel Aviv Sourasky Medical Center  Tel Aviv Israel"},{"name":"Faculty of Medicine Tel Aviv University  Tel Aviv Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ariel","family":"Many","sequence":"additional","affiliation":[{"name":"Lis Hospital for Women's Health Tel Aviv Sourasky Medical Center  Tel Aviv Israel"},{"name":"Faculty of Medicine Tel Aviv University  Tel Aviv Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yariv","family":"Yogev","sequence":"additional","affiliation":[{"name":"Lis Hospital for Women's Health Tel Aviv Sourasky Medical Center  Tel Aviv Israel"},{"name":"Faculty of Medicine Tel Aviv University  Tel Aviv Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4236-4836","authenticated-orcid":false,"given":"Emmanuel","family":"Attali","sequence":"additional","affiliation":[{"name":"Lis Hospital for Women's Health Tel Aviv Sourasky Medical Center  Tel Aviv Israel"},{"name":"Faculty of Medicine Tel Aviv University  Tel Aviv Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2025,1,18]]},"reference":[{"key":"e_1_2_10_2_1","doi-asserted-by":"publisher","DOI":"10.1007\/s10397-007-0333-2"},{"key":"e_1_2_10_3_1","doi-asserted-by":"publisher","DOI":"10.1177\/1933719111414206"},{"key":"e_1_2_10_4_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(80)91104-6"},{"key":"e_1_2_10_5_1","unstructured":"MichasF.Cesarean sections in selected countries 2018.2021https:\/\/www.statista.com\/statistics\/283123\/cesarean\u2010sections\u2010in\u2010oecd\u2010countries\/"},{"key":"e_1_2_10_6_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajog.2009.04.039"},{"key":"e_1_2_10_7_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajog.2006.12.017"},{"key":"e_1_2_10_8_1","doi-asserted-by":"publisher","DOI":"10.1080\/14767058.2018.1439010"},{"key":"e_1_2_10_9_1","doi-asserted-by":"publisher","DOI":"10.1111\/1471-0528.14708"},{"key":"e_1_2_10_10_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijgo.2004.08.016"},{"key":"e_1_2_10_11_1","doi-asserted-by":"publisher","DOI":"10.1097\/01.AOG.0000219750.79480.84"},{"key":"e_1_2_10_12_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0002-9378(99)70205-X"},{"key":"e_1_2_10_13_1","doi-asserted-by":"publisher","DOI":"10.1097\/01.AOG.0000149150.93552.78"},{"key":"e_1_2_10_14_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1471-0528.2004.00154.x"},{"key":"e_1_2_10_15_1","doi-asserted-by":"publisher","DOI":"10.12669\/pjms.35.6.539"},{"key":"e_1_2_10_16_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00464-002-9208-9"},{"key":"e_1_2_10_17_1","doi-asserted-by":"publisher","DOI":"10.1093\/humupd\/7.6.567"},{"key":"e_1_2_10_18_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.xagr.2023.100162"},{"key":"e_1_2_10_19_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ejogrb.2022.04.026"},{"key":"e_1_2_10_20_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12884-018-2111-8"},{"key":"e_1_2_10_21_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00404-02"},{"key":"e_1_2_10_22_1","volume-title":"Cesarean section","author":"Sung S","year":"2024"}],"container-title":["International Journal of Gynecology &amp; 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