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Carboxymethylcellulose Adhesion Barrier Placement at Primary Cesarean Delivery and Outcomes at Repeat Cesarean Delivery

Edwards, Rodney K. MD, MS; Ingersoll, Melissa RN, BSN; Gerkin, Richard D. MD, MS; Bodea-Braescu, Ana V. MSN, MPH, RN; Lin, Monique G. MD, MSPH

doi: 10.1097/AOG.0000000000000220
Contents: Original Research

OBJECTIVE: To assess associations of a commercially available carboxymethylcellulose adhesion barrier placed during primary cesarean delivery with clinical outcomes of repeat cesarean deliveries.

METHODS: We performed a retrospective cohort study of women undergoing primary cesarean delivery on or after January 1, 2008, and first repeat cesarean delivery in one of four hospitals in the same system by June 30, 2011. Women were included if both deliveries were live singletons at 34–42 weeks of gestation delivered through transverse abdominal incisions and the first hysterotomy was low transverse. Exclusion criteria included intervening delivery; puerperal infection, bowel injury, or bladder injury at primary cesarean delivery; uterine incision or laparotomy (except primary cesarean delivery) before repeat cesarean delivery; and use of another adhesion barrier at primary cesarean delivery. As a surrogate for adhesion grading, the primary outcome was time from skin incision to neonate delivery at repeat cesarean delivery. We also assessed total operative time and rates of selected surgical complications.

RESULTS: There were 517 women who met criteria; 248 received the adhesion barrier during primary cesarean delivery and 269 did not. There were no demographic differences between groups except delivery hospital. In the adhesion barrier and no adhesion barrier groups, respectively, mean±standard deviation times to delivery at repeat cesarean delivery were 6.1±3.0 compared with 5.8±2.5 minutes (P=.25), and total operative times were 31.2±10.6 compared with 31.8±11.6 minutes (P=.56). Surgical complications were not different between groups.

CONCLUSION: Placing a commercially available carboxymethylcellulose adhesion barrier at primary cesarean delivery is not associated with decreased time to delivery, total operative time, or complications during repeat cesarean deliveries.


Placing a carboxymethylcellulose adhesion barrier at primary cesarean delivery does not decrease time to delivery, total operative time, or likelihood of complications during repeat cesarean deliveries.

University of Alabama Birmingham School of Medicine, the Center for Women's Reproductive Health, Birmingham, Alabama; and Phoenix Perinatal Associates, a Division of Obstetrix Medical Group, Mednax, Inc, and the Department of Internal Medicine, Banner Good Samaritan Medical Center, Phoenix, Arizona.

Corresponding author: Rodney K. Edwards, MD, MS, 176F 10270J, 619 19th Street South, Birmingham, AL 35249-7333; e-mail:

Supported by departmental funds and a grant from Banner Good Samaritan Medical Center to Phoenix Perinatal Associates.

Presented at the 34th annual meeting of the Society for Maternal-Fetal Medicine, February 3–8, 2014, New Orleans, Louisiana.

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

© 2014 by The American College of Obstetricians and Gynecologists. Published by Wolters Kluwer Health, Inc. All rights reserved.