Assesment of intraabdominal adhesions using tissue elastography in relation to prior cesarean section number

Aim: This study aimed to evaluate whether intra-abdominal adhesions associated with the number of previous cesarean deliveries can be predicted noninvasively in the preoperative period using shear wave elastography. Materials and Methods: In this prospective study, pregnant women with two or more prior cesarean sections (Group 1, n = 45) and those with a single previous cesarean (Group 2, n = 45) were included. Before the scheduled cesarean, elastography was performed to measure subcutaneous tissue elasticity over the previous cesarean scar. During surgery, adhesions were assessed using the Nair classification and the Tulandi scoring system. The relationship between elastography measurements and adhesion severity was statistically analyzed. Results: The median elasticity values were 13.7 kPa (9.4–19.4) in Group 1 and 11.8 kPa (8.9–19.7) in Group 2 (p = 0.687). When cases were classified as no/mild versus moderate/severe adhesions according to the Tulandi scoring system, the median elasticity values were 12.1 kPa (8.9–19.3) and 13.6 kPa (9.4–20.1), respectively (p = 0.579). Using the modified Nair classification, median values were 12.3 kPa (8.5–19.7) for no/mild adhesions and 15.2 kPa (11.3–19.4) for moderate/severe adhesions (p = 0.190). No statistically significant correlation was observed between SWE values and adhesion severity in either classification system. Conclusion: Elastography did not demonstrate sufficient predictive value for determining the presence or severity of intra-abdominal adhesions prior to cesarean delivery. The findings indicate that SWE alone may not serve as a reliable preoperative predictive tool. Larger studies are needed to further clarify its predictive potential. Keywords: cesarean section, tissue elasticity, adhesion, prediction