Background: Cesarean section rate is increasing tremendously and adhesion formation becomes a common complication of Cesarean deliveries seeking more attention from day to day. Adhesion formation may be found in more than half of repeat Cesarean deliveries but still it is difficult to predict reliably severity or location of these adhesions before surgery. The state of intra-abdominal adhesion formation and peritoneal healing may be manifested by skin scar characteristics even though the degree of association has not been thoroughly investigated. Objective: To determine association between cesarean skin scar characteristics and intra abdominal adhesion found at repeat cesarean section among women who gave birth at Tibebe Ghion Specialised Hospital and Felegehiwot Referral Hospital, 2021. Method: cross sectional Institution based study was conducted on 192 women who gave birth by Cesarean delivery in two referral hospitals in Bahir Dar from May 1, 2021 to August 30, 2021. Study participants were selected with non-probability purposive sampling. A structured questionnaire was used to collect data. The collected data was cleaned, coded and entered on EPI DATA 3.1 and analyzed using SPSS version 26. Bivariate and multivariable logistic regression analysis was computed to identify statistically significant predictors with P value <0.05. Result: Of the total 192 women studied, the proportion of intra-abdominal adhesion was 23.4%, of which 12% of them had filmy adhesion and 10.4% of them had dense adhesions. Intra abdominal adhesions were significantly present in women with non-flat scar than in women with flat scar (51.1% versus 27.9%; P = 0.008) and in women with hyper-pigmented scar than non – pigmented scar group (66.7% versus 35.4%, P=0.001). Conclusion: cesarean hyper -pigmented skin scar and presence of non-flat scars can be associated with intra-abdominal adhesions during repeat Cesarean delivery and can be used as predictor variables. Key words: Cesarean delivery, Cesarean scar, Pelvic adhesions, Nair's score, intra-abdominal adhesion