Preventing adhesions and scar care after a C-section
The formation of post-surgical adhesions in the abdominal area is a relatively frequent phenomenon that can cause a number of problems with various clinical manifestations.
Adhesions form as a result of surgery in the abdominal area because the intervention disturbs a thin membrane (peritoneum) that covers the inside wall of the abdominal cavity as well as all the organs found in the cavity (such as the intestinal loops, urinary bladder, and uterus). Adhesions can form both after open and laparoscopic surgeries.
The severity of the symptoms caused by adhesions varies, as does the period of time between surgery and the appearance of the first symptoms. These can cause chronic pelvic pain, intestinal disorders, and problems during any future abdominal operations because they make the situation within the abdominal cavity unclear.
A C-section (cesarean section) is one of the most common open surgeries performed on women. The number of C-sections performed is rising globally across different healthcare systems. There are many causes and a number of objective reasons that can explain this rise. The most common risk factors include a higher maternal age for the first – and sometimes the only – delivery and a higher sickness rate among pregnant women who often have to undergo assisted reproduction treatments to conceive. The last two factors are also related to the “multiple birth epidemic” as well as the obesity epidemic, which also concerns the population of pregnant women.
Women who deliver via C-section are also at risk of developing adhesions after the procedure. The current strategy for reducing post-surgical adhesions after this obstetric surgery consists of the surgical technique employed during the procedure. The surgeon performs the procedure as gently as possible, respecting the anatomical boundaries and reducing bleeding and ischemia (the reduction of blood supply to tissues). Additionally, highly effective materials that are proven to reduce adhesions can also be used. The risk of adhesion formation in the area of surgery is highest during the first seven days after the procedure. Adhesions can be prevented by applying a mechanical membrane, which is then absorbed. Hyalobarrier gel is an easily-tolerated anti-adhesion barrier and is applied during surgery directly onto the scar on the uterus. It consists of 100% hyaluronic acid, which is produced naturally in the human body and is completely absorbed within a month. No allergic reactions have been reported. The efficacy of the gel in abdominal procedures has been attested by clinical studies.
The procedure requires surgical incisions in the skin to allow access to the abdominal cavity. While scar formation cannot be prevented, steps can be taken to heal the scar so that it is as unobtrusive as possible.
The process of scar maturation takes about three to six months, sometimes up to a year. In the beginning, the scar is red and only turns pale after several months. Scars can never be completely removed; they can only be made less visible. Besides the normal scar healing process, there is also a pathological process that results in the formation of keloidal or, more frequently, hypertrophic scars – raised tissue around the scar that spreads out.
Scar care should start immediately after surgery. The final appearance of the scar can be improved by well-chosen dressings (band-aids) in the early postoperative period. It is clinically proven that using special band-aids with a soft silicone layer has a positive impact on the final appearance of the scar. This is the material used in Mepilex Border Post Op, a highly absorbent surgical dressing. The special construction means that it takes good care of surgical wounds, helps speed up the healing process and also improves the condition of the sutures and the surrounding skin. Mepilex Border Post Op has a superabsorbent core that can absorb a large amount of exudate or blood and turn it into gel. The absorbent pad has a specific perforation pattern that gives patients unobstructed movement with the dressing while making sure that the dressing stays in place even when applied to the more mobile parts of the body. This means fewer dressing changes, which helps to keep costs down. A patented adherent layer made of soft Safetac® silicone maintains the optimal environment for the skin and mechanically prevents the scar from rising.
To prevent the formation of excessive scarring during the late postoperative period, it is recommended to follow the use of Mepilex Border Post Op with the Mepiform dressing. You can apply the dressing as soon as the surface of the wound has healed, preferably immediately after the removal of the sutures. To achieve the optimal results, it is important that the Mepiform dressing is used for 24 hours a day for at least 3 months.
The combined use of Mepilex Border Post Op followed by Mepiform improves the appearance and condition of the resulting scar and reduces pigment changes in the skin.
Doc. MUDr. Ladislav Krofta, CSc.
Institute for the Care of Mother and Child
Doc. MUDr. Ladislav Krofta, CSc.
Deputy director at the Institute for the Care of Mother and Child in Prague-Podolí (ICMC).
Graduate of the First Faculty of Medicine at Charles University specializing in obstetrics and gynecology, urogynecology, and maternal-fetal medicine.
Assistant Professor at the Third Faculty of Medicine at Charles University, member of the Department of Obstetrics and Gynecology at the Institute for Postgraduate Medical Education, member of the Advisory Council of the Czech Ministry of Justice, and member of the Accreditation Commission of the Czech Ministry of Health. He is also active in a number of professional organizations both in the Czech Republic and abroad.
Are you planning a C-section at the Institute for the Care of Mother and Child?
The ICMC maternity hospital is one of the biggest in the Czech Republic and also performs the most deliveries. The maternity hospital provides care to pregnant women from the start of their pregnancy up to delivery and postpartum care. The prenatal outpatient clinics provide regular checkups during pregnancy, while the high-risk pregnancy clinic monitors pregnant women with identified risks. The Prenatal Diagnostic Center employs highly experienced ultrasound diagnostic experts, geneticists, and specialized lab staff and focuses on the diagnosis of congenital developmental defects in the fetus and intrauterine risks to the fetus.
The ICMC has recently opened a Center of Fetal Medicine, which is unique in the Czech Republic and can treat certain conditions of the fetus directly in the uterus. The ICMC also has an inpatient department for women who are at risk of pregnancy loss. The delivery room is one of the most state-of-the-art facilities of its kind in the Czech Republic and includes an operating room for immediate surgery in the case of any risk to the fetus or the mother. The postpartum departments monitor the condition of the mother and child and help the mother care for her baby in the first days after delivery. Rooming-in is a standard practice at our facility and, of course, the gynecology outpatient clinic at ICMC will be happy to help with any postpartum complications after discharge from the maternity hospital. (Source)
“Is there anything I can do?”
Yes! You can help prevent complications after your C-section.
Factors such as the increasing number of multiple pregnancies, the higher average age of first-time mothers (this correlates with a higher rate of health complications during pregnancy), breech presentation, and obstructions in the birth canal mean that the number of cesarean deliveries or C-sections is on the rise. In these types of situations, they are primary (planned) C-sections. A C-section that is performed as an emergency measure because the life of the mother or the fetus is in danger is called a secondary C-section.
The professionals from the ICMC focus on both these groups of soon-to-be moms and try to alleviate any complications arising from this surgical procedure. This primarily includes the prevention of post-surgical adhesions (especially the adhesion of the uterus to another organ or the abdominal wall) and faster healing of the scars in the skin. The adhesion prevention measures include an anti-adhesion gel, while the scar healing is facilitated by two special types of dressing. The first of these helps speed up the healing process and improve the condition of the sutures and the surrounding skin. The second facilitates the scar maturation process and helps make the scar softer and paler.
As part of our premium services, the pharmacy at ICMC offers a C-SECTION SET containing products that help prevent the above-mentioned complications. The following sections of this website describe the set in more detail. And besides all the things for mom, the package also includes a wrap and a hat for the baby!
to make your recovery as fast as possible!
Enjoy the first days with your new baby
without needless worries and stress!