Clinical Investigation

Comparison of Efficiency of Clexane® “Enoxaparin Sodium” and Methylene Blue in Prevention of Adhesions After Cesarean Section in Pregnant Rats


  • Ahmet Emin Mutlu
  • Abdullah Boztosun
  • Dinçer Sümer
  • Ali Yanık

Turk J Obstet Gynecol 2012;9(4):216-223


To compare the effectiveness of fluid barriers, Clexane® “enoxaparin sodium” and methylene blue, in prevention of adhesion formation after cesarean section. We aimed to reduce the secondary infertility caused by adhesions after the operation


Pregnancy was terminated on the day 21 of gestation by cesarean section via bilateral uterine incision in 24 inbred, pregnant Wistar-Albino rats. The rats were divided into three groups.


The first group underwent standard surgery, where intra-peritoneal saline was given before abdominal closure. In the second group, methylene blue was sprayed on the defect at the anterior uterine horn after cesarean operation, whereas Clexane ® "Low-Molecular-Weight Heparin" (LMWH) was sprayed in the third group. After 3 weeks, all rats were sacrificed in order to determine the adhesion scores. Macroscopic and microscopic adhesion scores were statistically analyzed among groups.

Main outcome measures:

No significant difference was detected between methylene blue group and control group in terms of adhesion scores (p>0.05). It was found that adhesion scores in the LMWH group was significantly higher than the control group, suggesting that adhesions was increased by the administration of LMWH (p<0.05).


According to results of our study, direct application of liquid adhesion barriers to injured surface seems to be partially ineffective in the prevention of adhesions after cesarean section; rather, it was found that these liquid barriers which impairs control of bleeding might cause an increase in adhesion formation.

Keywords: rat, cesarean section, adhesion, low molecular weight heparin, methylene blue, secondary fertility.