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Cesarean Delivery Times and Adhesion Severity Associated With Prior Placement of a Sodium Hyaluronate-Carboxycellulose Barrier

OBJECTIVE: To evaluate the association between the prior use of a sodium hyaluronate-carboxycellulose adhesion barrier and the incision-to-delivery time and adhesion scores at first repeat cesarean delivery. METHODS: In this cohort study, intraoperative data were prospectively collected at the time of the study participants' first repeat cesarean delivery. Subsequent retrospective chart review of each patient's primary cesarean operative note was then performed to determine whether hyaluronate-carboxycellulose barrier film had been used. The primary outcome was incision-to-delivery time. Secondary outcomes were adhesion grade and blood loss. RESULTS: A total of 97 patients were analyzed; 71 did not have hyaluronate-carboxycellulose barrier film used during their primary cesarean and 26 did. Mean±standard deviation incision-to-delivery time was 9.5±4.3 minutes in the no hyaluronate-carboxycellulose barrier film group and 10.6±5.8 minutes in the hyaluronate-carboxycellulose barrier film group (P=.8). Average blood loss was 564±255 mL and 563±246 mL, respectively (P=.4). There was no difference between the mean fascia adhesion scores (1.45 compared with 1.31 Z −1.06, P=.29) and mean intraperitoneal adhesion scores (1.11 compared with 0.92 Z −1.09, P=.27). Our sample size yielded a power of 91% to detect a 5-minute difference in delivery times and 99% for a 1-point difference in adhesion scores. CONCLUSION: Our study showed no difference in the delivery time, blood loss, or adhesion scores at first repeat cesarean delivery between women who had hyaluronate-carboxycellulose barrier film placed at the time of their primary cesarean delivery and those who did not. LEVEL OF EVIDENCE: II