Complications due to adhesion formation following cesarean sections: a review of deliveries in three cases.

OBJECTIVE: To describe complications due to adhesion formation following cesarean sections and methods to prevent adhesion formation. DESIGN: Case reports. SETTING: Labor and delivery suites in three hospitals. PATIENT(S): [1] A 32-year-old G2P1 undergoing a repeat cesarean section with severe adhesions and subsequent bladder injury and repair. [2] A 36-year-old G3P1 undergoing a vaginal birth after cesarean (VBAC) with partial uterine dehiscence, fetal distress, and dense pelvic adhesions. [3] A 38-year-old G4P2 undergoing repeat cesarean section with dense adhesions from the uterus to the anterior abdominal wall. INTERVENTION(S): Cesarean sections, lysis of adhesions, and cystotomy repair. RESULT(S): All three patients had significant complications and sequelae secondary to dense uterine adhesions from previous cesarean sections. CONCLUSION(S): Adhesion prevention measures should be routinely implemented to reduce adhesion formation after cesarean deliveries and thus decrease corresponding sequelae. Critical steps to decrease adhesion formation include practicing meticulous surgical techniques, gentle tissue handling, minimizing ischemia and desiccation, controlling hemostasis, avoiding powdered gloves, and achieving peritoneal closure. Based on available data, adhesion barriers are effective in preventing or reducing adhesions after gynecologic surgery and have also been effective following cesarean sections.

Osteomyelitis of the pubic symphysis in pregnancy.

BACKGROUND: Pubic symphysis osteomyelitis during the antepartum period of pregnancy is rare. CASE: We report a patient in the third trimester who presented with pubic pain, low-grade fever, and altered gait. She was found to have a retropubic abscess at the time of cesarean delivery. Radiologic imaging showed findings consistent with osteomyelitis of the pubic symphysis and multiple pus collections in the pelvis and labia. The patient was treated with surgical debridement of the affected bone and placement of antibiotic-impregnated beads. CONCLUSION: Osteomyelitis of the pubic symphysis can have serious complications. The diagnosis should be considered in pregnant patients with clinical findings unusual for pubic symphysis diastases. It can be treated with antibiotic-impregnated beads.

Saphenous vein sparing during inguinal lymphadenectomy to reduce morbidity in patients with vulvar carcinoma.

OBJECTIVES: To compare short- and long-term morbidity associated with saphenous vein sparing versus ligation during inguinal lymphadenectomy for vulvar carcinoma. METHODS: A retrospective evaluation of patients with carcinoma of the vulva that underwent inguinal lymphadenectomy was performed. Operative reports were evaluated and patients were divided into those who had sparing of the saphenous vein versus ligation. Postoperative short- and long-term complications were compared between the two groups using Pearson chi squared analysis. RESULTS: There were a total of 49 inguinal lymphadenectomies performed on 29 patients. The saphenous vein was spared in 18 (37%) groin dissections compared to 31(63%) in which the saphenous vein was ligated. The two groups were similar in regards to clinical characteristics. All patients received closed suction drains and prophylactic antibiotics. Median number of nodes dissected was similar. Cellulitis was more common in the vein-ligated group compared to the vein-spared group (45% vs. 0%; P < 0.001). Wound breakdown occurred in 25% of dissections where the saphenous vein was ligated versus 0% in dissections where the vein was spared (P = or < 0.02). Short-term edema (< or = 6 months) was similar between vein-ligated and vein-spared groups (67% vs. 72%, P < 1.0). Subsequently, chronic lymphedema (> 6 months) persisted in 38% of the vein-ligated group compared to 11% in the vein-spared group (P < 0.05). The incidence of recurrent disease was similar in both groups (19.3 % vs. 22.2% P < 0.1). CONCLUSIONS: Routine preservation of the saphenous vein during inguinal lymphadenectomy for vulvar carcinoma may reduce the incidence of wound cellulitis, wound breakdown, and chronic lymphedema.