{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,27]],"date-time":"2026-06-27T23:48:08Z","timestamp":1782604088458,"version":"3.54.5"},"reference-count":53,"publisher":"Elsevier BV","issue":"5","license":[{"start":{"date-parts":[[2014,11,1]],"date-time":"2014-11-01T00:00:00Z","timestamp":1414800000000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/www.elsevier.com\/tdm\/userlicense\/1.0\/"},{"start":{"date-parts":[[2014,11,1]],"date-time":"2014-11-01T00:00:00Z","timestamp":1414800000000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/www.elsevier.com\/legal\/tdmrep-license"}],"content-domain":{"domain":["ajog.org","clinicalkey.com","clinicalkey.com.au","clinicalkey.es","clinicalkey.fr","clinicalkey.jp","elsevier.com","sciencedirect.com"],"crossmark-restriction":true},"short-container-title":["American Journal of Obstetrics and Gynecology"],"published-print":{"date-parts":[[2014,11]]},"DOI":"10.1016\/j.ajog.2014.05.027","type":"journal-article","created":{"date-parts":[[2014,5,22]],"date-time":"2014-05-22T10:38:58Z","timestamp":1400755138000},"page":"446-452","update-policy":"https:\/\/doi.org\/10.1016\/elsevier_cm_policy","source":"Crossref","is-referenced-by-count":26,"title":["Adhesion prevention after cesarean delivery: evidence, and lack of it"],"prefix":"10.1016","volume":"211","author":[{"given":"Asnat","family":"Walfisch","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ron","family":"Beloosesky","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alon","family":"Shrim","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mordechai","family":"Hallak","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"78","reference":[{"key":"10.1016\/j.ajog.2014.05.027_bib1","series-title":"Evidence-based maternity care: what it is and what it can achieve","author":"Sakala","year":"2008"},{"key":"10.1016\/j.ajog.2014.05.027_bib2","first-page":"285","article-title":"Rates of cesarean delivery\u2014United States, 1991. Centers for Disease Control and Prevention (CDC)","volume":"42","year":"1993","journal-title":"Morb Mortal Wkly Rep"},{"key":"10.1016\/j.ajog.2014.05.027_bib3","first-page":"1","article-title":"Births: preliminary data for 2007","volume":"57","author":"Hamilton","year":"2009","journal-title":"Natl Vital Stat Rep"},{"key":"10.1016\/j.ajog.2014.05.027_bib4","doi-asserted-by":"crossref","first-page":"179","DOI":"10.1016\/j.clp.2011.03.007","article-title":"Recent trends and patterns in cesarean and vaginal birth after cesarean (VBAC) deliveries in the United States","volume":"38","author":"MacDorman","year":"2011","journal-title":"Clin Perinatol"},{"key":"10.1016\/j.ajog.2014.05.027_bib5","unstructured":"Organization for Economic Cooperation and Development. OECD health data 2013. Available at: http:\/\/www.oecd.org\/health\/health-systems\/oecdhealthdata2013-frequentlyrequesteddata.htm. Accessed Feb. 10,\u00a02014."},{"key":"10.1016\/j.ajog.2014.05.027_bib6","unstructured":"Martin, JA, Hamilton, BE, Ventura SJ, et\u00a0al. Births: final data for 2009. Natl Vital Stat Rep. Available at: http:\/\/www.cdc.gov.sheba-ez.medlcp.tau.ac.il\/nchs\/data\/nvsr\/nvsr60\/nvsr60_01.pdf. Accessed March 27,\u00a02014."},{"key":"10.1016\/j.ajog.2014.05.027_bib7","doi-asserted-by":"crossref","first-page":"1503","DOI":"10.1002\/bjs.7657","article-title":"Pathogenesis of postoperative adhesion formation","volume":"98","author":"Hellebrekers","year":"2011","journal-title":"Br J Surg"},{"key":"10.1016\/j.ajog.2014.05.027_bib8","first-page":"273","article-title":"Pelvic adhesions","volume":"7","author":"Diamond","year":"1998","journal-title":"Surg Technol Int"},{"key":"10.1016\/j.ajog.2014.05.027_bib9","doi-asserted-by":"crossref","first-page":"219","DOI":"10.1016\/S0015-0282(16)56507-8","article-title":"Contemporary adhesion prevention","volume":"61","author":"DiZerega","year":"1994","journal-title":"Fertil Steril"},{"key":"10.1016\/j.ajog.2014.05.027_bib10","doi-asserted-by":"crossref","first-page":"56.e1","DOI":"10.1016\/j.ajog.2009.04.039","article-title":"Adhesion development and morbidity after repeat cesarean delivery","volume":"201","author":"Tulandi","year":"2009","journal-title":"Am J Obstet Gynecol"},{"key":"10.1016\/j.ajog.2014.05.027_bib11","doi-asserted-by":"crossref","first-page":"127","DOI":"10.1016\/0020-7292(95)02561-8","article-title":"Sequelae of repeat cesarean sections","volume":"52","author":"Soltan","year":"1996","journal-title":"Int J Gynaecol Obstet"},{"key":"10.1016\/j.ajog.2014.05.027_bib12","doi-asserted-by":"crossref","first-page":"227","DOI":"10.1016\/j.ijgo.2004.08.016","article-title":"Multiple cesarean section morbidity","volume":"87","author":"Makoha","year":"2004","journal-title":"Int J Gynaecol Obstet"},{"key":"10.1016\/j.ajog.2014.05.027_bib13","doi-asserted-by":"crossref","first-page":"461.e1","DOI":"10.1016\/j.ajog.2006.12.017","article-title":"Post cesarean delivery adhesions associated with delayed delivery of infant","volume":"196","author":"Morales","year":"2007","journal-title":"Am J Obstet Gynecol"},{"key":"10.1016\/j.ajog.2014.05.027_bib14","doi-asserted-by":"crossref","first-page":"171","DOI":"10.1016\/j.ejogrb.2004.07.022","article-title":"Multiple repeat caesarean section: is it safe?","volume":"119","author":"Uygur","year":"2005","journal-title":"Eur J Obstet Gynecol Reprod Biol"},{"key":"10.1016\/j.ajog.2014.05.027_bib15","doi-asserted-by":"crossref","first-page":"25","DOI":"10.1007\/s10397-012-0765-1","article-title":"Classification of intra-abdominal adhesions after cesarean delivery","volume":"10","author":"Tulandi","year":"2013","journal-title":"Gynecol Surg"},{"key":"10.1016\/j.ajog.2014.05.027_bib16","doi-asserted-by":"crossref","first-page":"1166","DOI":"10.1177\/1933719111414206","article-title":"Postoperative adhesion development following cesarean and open intra-abdominal gynecological operations: a review","volume":"18","author":"Awonuga","year":"2011","journal-title":"Reprod Sci"},{"key":"10.1016\/j.ajog.2014.05.027_bib17","doi-asserted-by":"crossref","first-page":"417","DOI":"10.3109\/00016348609157375","article-title":"Fibrinolytic activity in amniotic fluid during late pregnancy","volume":"65","author":"Pschera","year":"1986","journal-title":"Acta Obstet Gynecol Scand"},{"key":"10.1016\/j.ajog.2014.05.027_bib18","doi-asserted-by":"crossref","first-page":"275","DOI":"10.1097\/01.AOG.0000171120.81732.4c","article-title":"Peritoneal closure at primary cesarean delivery and adhesions","volume":"106","author":"Lyell","year":"2005","journal-title":"Obstet Gynecol"},{"key":"10.1016\/j.ajog.2014.05.027_bib19","doi-asserted-by":"crossref","first-page":"82","DOI":"10.1016\/j.ijgo.2012.11.008","article-title":"Time between skin incision and delivery during cesarean","volume":"121","author":"Rossouw","year":"2013","journal-title":"Int J Gynaecol Obstet"},{"key":"10.1016\/j.ajog.2014.05.027_bib20","doi-asserted-by":"crossref","first-page":"21","DOI":"10.1097\/01.AOG.0000222380.11069.11","article-title":"Maternal complications associated with multiple cesarean deliveries","volume":"108","author":"Nisenblat","year":"2006","journal-title":"Obstet Gynecol"},{"key":"10.1016\/j.ajog.2014.05.027_bib21","doi-asserted-by":"crossref","first-page":"719","DOI":"10.1111\/j.1600-0412.2012.01395.x","article-title":"Clinical and economic impact of adhesiolysis during repeat cesarean delivery","volume":"91","author":"Sikirica","year":"2012","journal-title":"Acta Obstet Gynecol Scand"},{"key":"10.1016\/j.ajog.2014.05.027_bib22","doi-asserted-by":"crossref","first-page":"406.e1","DOI":"10.1016\/j.ajog.2010.07.013","article-title":"Cesarean delivery and risk for postoperative adhesions and intestinal obstruction: a nested case-control study of the Swedish Medical Birth Registry","volume":"203","author":"Andolf","year":"2010","journal-title":"Am J Obstet Gynecol"},{"key":"10.1016\/j.ajog.2014.05.027_bib23","doi-asserted-by":"crossref","first-page":"1226","DOI":"10.1097\/01.AOG.0000219750.79480.84","article-title":"Maternal morbidity associated with multiple repeat cesarean deliveries","volume":"107","author":"Silver","year":"2006","journal-title":"Obstet Gynecol"},{"key":"10.1016\/j.ajog.2014.05.027_bib24","doi-asserted-by":"crossref","first-page":"1162","DOI":"10.1097\/01.AOG.0000239098.33320.c4","article-title":"Adhesion-related bowel obstruction after hysterectomy for benign conditions","volume":"108","author":"Al-Sunaidi","year":"2006","journal-title":"Obstet Gynecol"},{"key":"10.1016\/j.ajog.2014.05.027_bib25","doi-asserted-by":"crossref","first-page":"543","DOI":"10.1093\/humrep\/dem428","article-title":"Pregnancy after Caesarean section: fewer or later?","volume":"23","author":"Eijsink","year":"2008","journal-title":"Hum Reprod"},{"key":"10.1016\/j.ajog.2014.05.027_bib26","doi-asserted-by":"crossref","first-page":"693","DOI":"10.1097\/01.AOG.0000444441.04111.1d","article-title":"Obstetric care consensus no. 1: safe prevention of the primary cesarean delivery","volume":"123","year":"2014","journal-title":"Obstet Gynecol"},{"key":"10.1016\/j.ajog.2014.05.027_bib27","doi-asserted-by":"crossref","first-page":"300","DOI":"10.1016\/j.ejogrb.2011.09.001","article-title":"Effect of avoiding bladder flap formation in caesarean section on repeat caesarean delivery","volume":"159","author":"Malvasi","year":"2011","journal-title":"Eur J Obstet Gynecol Reprod Biol"},{"key":"10.1016\/j.ajog.2014.05.027_bib28","doi-asserted-by":"crossref","first-page":"690","DOI":"10.1111\/j.1471-0528.2010.02529.x","article-title":"Single- versus double-layer hysterotomy closure at primary caesarean delivery and bladder adhesions","volume":"117","author":"Blumenfeld","year":"2010","journal-title":"BJOG"},{"key":"10.1016\/j.ajog.2014.05.027_bib29","doi-asserted-by":"crossref","first-page":"1235","DOI":"10.1111\/j.1447-0756.2011.01777.x","article-title":"Comparative analysis of long-term outcomes of Misgav Ladach technique cesarean section and traditional cesarean section","volume":"38","author":"Ghahiry","year":"2012","journal-title":"J\u00a0Obstet Gynaecol Res"},{"key":"10.1016\/j.ajog.2014.05.027_bib30","doi-asserted-by":"crossref","first-page":"157","DOI":"10.1080\/14767050802647478","article-title":"Incidence of post-operative adhesions following Misgav Ladach caesarean section\u2014a comparative study","volume":"22","author":"Fatusi\u0107","year":"2009","journal-title":"J\u00a0Matern Fetal Neonatal Med"},{"key":"10.1016\/j.ajog.2014.05.027_bib31","first-page":"CD000163","article-title":"Closure versus non-closure of the peritoneum at caesarean section","volume":"4","author":"Bamigboye","year":"2003","journal-title":"Cochrane Database Syst Rev"},{"key":"10.1016\/j.ajog.2014.05.027_bib32","doi-asserted-by":"crossref","first-page":"429","DOI":"10.1080\/01443610600720287","article-title":"A\u00a0randomised controlled study of non-closure of peritoneum at caesarean section in a Nigerian population","volume":"26","author":"Malomo","year":"2006","journal-title":"J\u00a0Obstet Gynaecol"},{"key":"10.1016\/j.ajog.2014.05.027_bib33","doi-asserted-by":"crossref","first-page":"396","DOI":"10.1111\/j.1447-0756.2006.00420.x","volume":"32","author":"Komoto","year":"2006","journal-title":"J\u00a0Obstet Gynaecol Res"},{"key":"10.1016\/j.ajog.2014.05.027_bib34","doi-asserted-by":"crossref","first-page":"745","DOI":"10.1016\/j.gyobfe.2005.08.001","article-title":"Caesarean section: closure or non-closure of peritoneum? A randomized trial of postoperative morbidity","volume":"33","author":"Huchon","year":"2005","journal-title":"Gynecol Obstet Fertil"},{"key":"10.1016\/j.ajog.2014.05.027_bib35","doi-asserted-by":"crossref","first-page":"541","DOI":"10.1016\/j.jgyn.2011.06.004","article-title":"Towards a simplification of caesarean section technique: non-closure of peritoneum?","volume":"40","author":"Malek-Mellouli","year":"2011","journal-title":"J\u00a0Gynecol Obstet Biol Reprod"},{"key":"10.1016\/j.ajog.2014.05.027_bib36","doi-asserted-by":"crossref","first-page":"40","DOI":"10.1016\/S0301-2115(02)00366-4","article-title":"Nonclosure of the peritoneum during caesarean section: long-term follow-up of a randomised controlled trial","volume":"108","author":"Roset","year":"2003","journal-title":"Eur J Obstet Gynecol Reprod Biol"},{"key":"10.1016\/j.ajog.2014.05.027_bib37","doi-asserted-by":"crossref","first-page":"1366","DOI":"10.1111\/j.1471-0528.2010.02686.x","article-title":"Caesarean section surgical techniques: a randomized factorial trial (CAESAR)","volume":"117","year":"2010","journal-title":"BJOG"},{"key":"10.1016\/j.ajog.2014.05.027_bib38","doi-asserted-by":"crossref","first-page":"234","DOI":"10.1016\/S0140-6736(13)60441-9","article-title":"Caesarean section surgical techniques (CORONIS): a fractional, factorial, unmasked, randomised controlled trial","volume":"382","year":"2013","journal-title":"Lancet"},{"key":"10.1016\/j.ajog.2014.05.027_bib39","doi-asserted-by":"crossref","first-page":"410","DOI":"10.1111\/j.1471-0528.2010.02808.x","article-title":"Adhesion formation after previous caesarean section\u2014a meta-analysis and systematic review","volume":"118","author":"Shi","year":"2011","journal-title":"BJOG"},{"key":"10.1016\/j.ajog.2014.05.027_bib40","doi-asserted-by":"crossref","first-page":"3","DOI":"10.1016\/j.ejogrb.2009.06.003","article-title":"To close or not to close? A systematic review and a meta-analysis of peritoneal non-closure and adhesion formation after caesarean section","volume":"147","author":"Cheong","year":"2009","journal-title":"Eur J Obstet Gynecol Reprod Biol"},{"key":"10.1016\/j.ajog.2014.05.027_bib41","doi-asserted-by":"crossref","first-page":"56.e1","DOI":"10.1016\/j.ajog.2011.07.032","article-title":"Effect of closure versus nonclosure of peritoneum at cesarean section on adhesions: a prospective randomized study","volume":"206","author":"Kapustian","year":"2012","journal-title":"Am J Obstet Gynecol"},{"key":"10.1016\/j.ajog.2014.05.027_bib42","doi-asserted-by":"crossref","first-page":"215","DOI":"10.1186\/1471-2393-13-215","article-title":"CORONIS: the international study of caesarean section surgical techniques: the follow-up study","volume":"13","year":"2013","journal-title":"BMC Pregnancy Childbirth"},{"key":"10.1016\/j.ajog.2014.05.027_bib43","first-page":"CD000475","article-title":"Barrier agents for adhesion prevention after gynaecological surgery","author":"Ahmad","year":"2008","journal-title":"Cochrane Database Syst Rev"},{"key":"10.1016\/j.ajog.2014.05.027_bib44","doi-asserted-by":"crossref","first-page":"b2535","DOI":"10.1136\/bmj.b2535","article-title":"Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement","volume":"339","author":"Moher","year":"2009","journal-title":"BMJ"},{"key":"10.1016\/j.ajog.2014.05.027_bib45","first-page":"1","article-title":"Breastfeeding and maternal and infant health outcomes in developed countries","volume":"153","author":"Ip","year":"2007","journal-title":"Evid Rep Technol Assess"},{"key":"10.1016\/j.ajog.2014.05.027_bib46","first-page":"557","article-title":"Efficacy of Seprafilm as an adhesion prevention barrier in cesarean sections","volume":"91","author":"Fushiki","year":"2005","journal-title":"Obstet Gynecol Treatment"},{"key":"10.1016\/j.ajog.2014.05.027_bib47","first-page":"103","article-title":"Peritoneal adhesion prevention at cesarean section: an analysis of the effectiveness of an absorbable adhesion barrier","volume":"56","author":"Chapa","year":"2011","journal-title":"J\u00a0Reprod Med"},{"key":"10.1016\/j.ajog.2014.05.027_bib48","doi-asserted-by":"crossref","first-page":"923","DOI":"10.1097\/AOG.0000000000000220","article-title":"Carboxymethylcellulose adhesion barrier placement at primary cesarean delivery and outcomes at repeat cesarean delivery","volume":"123","author":"Edwards","year":"2014","journal-title":"Obstet Gynecol"},{"key":"10.1016\/j.ajog.2014.05.027_bib49","unstructured":"Easley H. A trial to reduce adhesions following a primary cesarean section. ClinicalTrials.gov. US National Institutes of Health. Available at: http:\/\/clinicaltrials.gov\/ct2\/show\/NCT01819467?term=adhesion+prevention+AND+cesarean&rank=3. Accessed March 21,\u00a02014."},{"key":"10.1016\/j.ajog.2014.05.027_bib50","unstructured":"Kiefer D. Seprafilm adhesion barrier and cesarean delivery. ClinicalTrials.gov. US National Institutes of Health. Available at: http:\/\/clinicaltrials.gov\/ct2\/show\/NCT00565643. Accessed March 21,\u00a02014."},{"key":"10.1016\/j.ajog.2014.05.027_bib51","unstructured":"Peleg D. Seprafilm for Prevention of Adhesions at Repeat Cesarean (SPARC). ClinicalTrials.gov. US National Institutes of Health. Available at: http:\/\/clinicaltrials.gov\/ct2\/show\/NCT00697606. Accessed March 21,\u00a02014."},{"key":"10.1016\/j.ajog.2014.05.027_bib52","doi-asserted-by":"crossref","first-page":"739","DOI":"10.1016\/j.ygyno.2006.09.029","article-title":"Prevention of adhesion formation after radical hysterectomy using a sodium hyaluronate-carboxymethylcellulose (HA-CMC) barrier: a cost-effectiveness analysis","volume":"104","author":"Bristow","year":"2007","journal-title":"Gynecol Oncol"},{"key":"10.1016\/j.ajog.2014.05.027_bib53","doi-asserted-by":"crossref","first-page":"157","DOI":"10.1097\/AOG.0b013e31821d8438","article-title":"Adhesion barriers at cesarean delivery: advertising compared with the evidence","volume":"118","author":"Albright","year":"2011","journal-title":"Obstet Gynecol"}],"container-title":["American Journal of Obstetrics and Gynecology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/api.elsevier.com\/content\/article\/PII:S0002937814004955?httpAccept=text\/xml","content-type":"text\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/api.elsevier.com\/content\/article\/PII:S0002937814004955?httpAccept=text\/plain","content-type":"text\/plain","content-version":"vor","intended-application":"text-mining"}],"deposited":{"date-parts":[[2025,9,11]],"date-time":"2025-09-11T10:58:03Z","timestamp":1757588283000},"score":1,"resource":{"primary":{"URL":"https:\/\/linkinghub.elsevier.com\/retrieve\/pii\/S0002937814004955"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2014,11]]},"references-count":53,"journal-issue":{"issue":"5","published-print":{"date-parts":[[2014,11]]}},"alternative-id":["S0002937814004955"],"URL":"https:\/\/doi.org\/10.1016\/j.ajog.2014.05.027","relation":{},"ISSN":["0002-9378"],"issn-type":[{"value":"0002-9378","type":"print"}],"subject":[],"published":{"date-parts":[[2014,11]]},"assertion":[{"value":"Elsevier","name":"publisher","label":"This article is maintained by"},{"value":"Adhesion prevention after cesarean delivery: evidence, and lack of it","name":"articletitle","label":"Article Title"},{"value":"American Journal of Obstetrics and Gynecology","name":"journaltitle","label":"Journal Title"},{"value":"https:\/\/doi.org\/10.1016\/j.ajog.2014.05.027","name":"articlelink","label":"CrossRef DOI link to publisher maintained version"},{"value":"article","name":"content_type","label":"Content Type"},{"value":"Copyright \u00a9 2014 Elsevier Inc. All rights reserved.","name":"copyright","label":"Copyright"}]}}