Background: The most serious post-CS complication is intra-abdominal adhesions. There is no accurate method for pre-operative identification of intra-abdominal adhesion.

Aim of the present study to detect the presence of certain CS scars characteristics which might have value in predicting occurrences and degree of intra-abdominal adhesions.

Methods: this is a retrospective cohort study in which patients data were collected from patients files.

We included 150 patients with past history of Pfannenstiel incision CSs, with gestational age that was about around 36 weeks. Score values of this system is ranged from 5 - 25

Results: We showed that females with higher indices of the scar had higher rates of adhesion than others. We showed that adhesion occur more in women with a past history of 2 CSs or more (P =0.002).

We showed that the sensitivity of evaluation of the CS scar index in detecting intra-abdominal adhesions was 60%, specificity was 31%, positive and negative predictive values were 29%, and 78% respectively.

Conclusions: We concluded that patients with a higher scar index were be more liable to occurrence of more severe adhesions than patients with low score index.