Closure vs. nonclosure of the peritoneum at cesarean delivery

To compare the frequency and severity of celiac adhesions following cesarean sections performed with and without closure of the parietal and visceral peritoneum. A retrospective cohort study involved 612 women who underwent their second lower-segment transverse cesarean section. Nonclosure of the parietal peritoneum at the time of the first cesarean section was associated with significantly more visceral adhesions than closure (16.2% vs. 8.1%; P = 0.003), and closure of the visceral peritoneum had a similar effect (16.1% vs. 6.7%; P = 0.02). However, the difference in rates of severe adhesions was not statistically significant (12.9% vs. 17.6%; P = 0.12). After controlling for confounding variables, it was found that closure of the parietal peritoneum reduced the rate of visceral adhesions 2.7-fold. Trial of labor before and fever after surgery increased the risk of severe adhesions 6.1-fold and 5.6-fold, respectively. Nonclosure of the peritoneum at primary cesarean section is associated with a significantly increased risk of visceral adhesions.