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)-beta 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, plateletto-lymphocyte ratio, and systemic immune-inflammation index, TGF-beta, 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-beta 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-beta was significant (p < 0.05). The effect of the PAI score on TGF-beta was higher than that of IL-6. As a reciprocal relationship, the effect of the TGF-beta 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-beta 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.