Role of peripheral inflammatory biomarkers, transforming growth factor-beta and interleukin 6 in predicting peritoneal adhesions following repeat cesarean delivery.

ABSTRACT

BACKGROUND: Repeat cesarean deliveries (CDs) pose a risk in the development of intra-abdominal adhesions. AIM: We aimed to examine the incidence and severity of adhesions in repeat CDs using a specific scoring system and assess the predictive power of the pre-operative value of transforming growth factor (TGF)-ß and interleukin (IL)-6 with selected peripheral inflammatory biomarkers (PIBs) in the prediction of adhesion formation. METHODS: This prospective study enrolled 91 pregnant women at term, who had previously undergone at least one or more scheduled CDs. PIBs, namely C-reactive protein, white blood cell count, neutrophil-to-lymphocyte ratio, platelet-to-lymphocyte ratio, and systemic immune-inflammation index, TGF-ß, and IL-6 were studied according to the presence and location of adhesions. RESULTS: There was a significant difference only in the variables of the number of CDs, post-operative adhesion index (PAI) score, IL-6, and TGF-ß on the presence of adhesion (p < 0.05). The linear regression model revealed that the effect of the number of CDs, PAI score, and IL-6 values on TGF-ß was significant (p < 0.05). The effect of the PAI score on TGF-ß was higher than that of IL-6. As a reciprocal relationship, the effect of the TGF-ß value on the PAI score was also higher than that of IL-6. CONCLUSION: In patients with a history of repeat CDs, the preoperative determination of TGF-ß seems to be an important independent predictor of POA. The adverse events due to post-operative adhesion caused by repeat CDs can be overcome by detecting high-risk patients with a comprehensive assessment and individualized intervention integrated into overall patient management.