Preoperative sonographic sliding sign for prediction of intra‐abdominal adhesions before repeat cesarean delivery

Abstract

Objective To evaluate the usefulness of the uterine sliding sign for predicting intra‐abdominal adhesions in women undergoing repeat cesarean section (CS) and the association of the sliding sign with other operative and neonatal outcomes. Methods A prospective cohort study was conducted among pregnant women with at least one previous CS. Transabdominal ultrasonography was performed and classified as a positive or negative sliding sign. Surgeons blinded to the sonographic results assessed intra‐abdominal adhesions. The sensitivity, specificity, positive predictive value, and negative predictive value were calculated. Operative and neonatal outcomes of the positive and negative sliding sign groups were compared. Factors associated with intraoperative adhesions were also analyzed. Results A total of 380 women were recruited. The sensitivity and specificity of the uterine sliding sign to detect moderate‐to‐thick adhesions were 60.6% and 91.9%, respectively. A negative sliding sign was significantly associated with a higher incidence of adhesions, longer skin‐to‐delivery time, longer total operative time, and lower 5‐min APGAR score in newborns. A negative sliding sign and history of two or more previous CS were significant predictors of moderate‐to‐thick adhesions. Conclusion The uterine sliding sign is an independent predictor of intraoperative adhesions, with acceptable sensitivity and high specificity and negative predictive value.

Sonographic Sliding Sign as a Predictor of Intra- Abdominal Adhesions in Pregnant Woman with Previous Pelvi-Abdominal Surgery

“…We found that the duration of this condition was substantially longer in persons who had a negative sliding sign compared to those who had a positive sliding sign (the median was 16.5 minutes vs 6 minutes, and the p-value for this comparison was more than 0.001). The findings of Drukker et al (11) , who observed a considerably longer delivery time among those who had a negative sliding sign, are supported by our data, which are congruent with their findings.…”

“…According to these results, the sliding sign is an accurate predictor of adhesions that occur during CS, and there is only a small probability that this is a coincidence. These findings are in line with those obtained by Drukker et al (11) , who discovered that a positive sliding sign accurately identified pregnant women who previously had CS and stated that during the CS procedure, a positive sliding sign was able to successfully identify zero or minimum adhesions in 329 out of 340 persons, but a negative sliding sign was only able to accurately detect considerable adhesions in 16 out of 30 individuals. These findings have been confirmed by the current study.…”

“…According to the findings of Drukker et al (11) , this study showed that the sliding sign had a sensitivity of 71.4%, a specificity of 95.2%, a PPV of 62.5%, and a NPV of 96.7% when it came to predicting marked intra-operative adhesions. Also, they reported that when it came to the identification of severe adhesions, they found that the test had a sensitivity of 56%, a specificity of 95%, a positive likelihood ratio of 12.1, and a negative likelihood ratio of 0.46.…”

“…Previous research has employed the sliding sign as a predictor of intra-abdominal adhesions, either on its own or in conjunction with stria gravidarum and CS scar (11)(12)(13)(14)(15)(16) . Previous research has used transvaginal ultrasound, magnetic resonance imaging (MRI), and computed tomography (CT) of the abdomen to predict adhesions in female patients with probable endometriosis or other pelvic diseases (4,17) .…”

Evaluation of the Preoperative Slide Test in the Prediction of Intra-Abdominal Adhesions: A Single-Center, Double-Blinded, Prospective Observational Study

“…According to a prospective cohort study, an absence of relative movement between the abdominal and uterine walls on ultrasound was associated with a higher incidence of adhesions, a longer skin-to-delivery time, and a lower five-minute APGAR score in newborns. 19 In another study conducted on pregnant women with at least 1 previous cesarean delivery, the sliding sign by ultrasound had a sensitivity of 100%, specificity of 86.84%, a positive predictive value of 81.5, a negative predictive value of 100, and accuracy of 91.67. 20 Both studies emphasized that the slide test is an effective method for detecting intra-abdominal adhesions in women with a history of cesarean section.…”