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Adhesion Barriers at Cesarean Delivery: Advertising Compared With the Evidence

Albright, Catherine M. MD; Rouse, Dwight J. MD

doi: 10.1097/AOG.0b013e31821d8438
Current Commentary

Cesarean delivery, the most common surgery performed in the United States, is complicated by adhesion formation in 24–73% of cases. Because adhesions have potential sequelae, different synthetic adhesion barriers are currently heavily marketed as a means of reducing adhesion formation resultant from cesarean delivery. However, their use for this purpose has been studied in only two small, nonblinded and nonrandomized trials, both of which were underpowered and subject to bias. Neither demonstrated improvement in meaningful clinical outcomes. In the only cost-effectiveness analysis of adhesion barriers to date, the use of synthetic adhesion barriers was cost-effective only when the subsequent rate of small bowel obstruction was at least 2.4%, a rate far higher than that associated with cesarean delivery. In fact, intra-abdominal adhesions from prior cesarean delivery rarely cause maternal harm and have not been demonstrated to adversely affect perinatal outcome. Based on our review of the available literature, we think the use of adhesion barriers at the time of cesarean delivery would be ill-advised at the present time.

Given the paucity of supportive data and high costs associated with placement of adhesion barriers at cesarean delivery, using them during cesarean delivery should be discouraged.

From Women and Infants Hospital, Brown University, Providence, Rhode Island.

Corresponding author: Catherine M. Albright, MD, Brown University, Department of Obstetrics and Gynecology, 101 Dudley St., Providence, RI 02905; e-mail: calbright@wihri.org.

Financial Disclosure The authors did not report any potential conflicts of interest.

© 2011 The American College of Obstetricians and Gynecologists