Sliding sign in third‐trimester sonographic evaluation of intra‐abdominal adhesions in women undergoing repeat Cesarean section: a novel technique

Baron, Joel; Tirosh, Dan; Mastrolia, Salvatore Andrea; Ben-Haroush, Y.; Schwartz, Shepard; Kerner, Yoav; Hershkovitz, Reli

doi:10.1002/uog.19057

Cited by 23 publications

(33 citation statements)

References 17 publications

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“…The inclusion of this test has not yet been adopted by any major obstetrics/gynecology governing body. However, knowledge of the utility of this technique is spreading, with studies looking at the sliding sign in other contexts such as repeat Cesarean section 9,24 and the detection of intra-abdominal adhesions 10 . Further adoption of the technique is also encouraged by a reasonably achievable learning curve 4,5,25 .…”

Section: Discussionmentioning

confidence: 99%

“…Further adoption of the technique is also encouraged by a reasonably achievable learning curve 4,5,25 . The high value of preoperative knowledge of POD obliteration is well understood in endometriosis surgery 11 and the potential for predicting intra-abdominal adhesions, by performing the anterior sliding-sign test, has recently been recognized for surgical decision-making in Cesarean section 9,24 . It is reasonable to think that gynecologists may soon request knowledge of the anterior and posterior compartment obliteration status before performing a hysterectomy.…”

Section: Discussionmentioning

confidence: 99%

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Prevalence of negative sliding sign representing pouch of Douglas obliteration during pelvic transvaginal ultrasound for any indication

Leonardi

Martins

Espada

et al. 2020

Ultrasound in Obstet & Gyne

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Objectives Pouch of Douglas (POD) obliteration can be predicted with a high degree of certainty and reproducibility using the dynamic transvaginal ultrasound (TVS) sliding‐sign technique. So far, studies on POD obliteration prediction have focused on tertiary‐care populations with high prevalence of endometriosis; however, POD obliteration may exist in individuals with asymptomatic endometriosis or other conditions. Our primary aim was to determine the prevalence of a negative sliding sign, representing POD obliteration, in a cohort of patients undergoing TVS for any gynecological indication. Methods This was a prospective observational study of consecutive women with an indication for gynecological TVS, conducted at a high‐volume ultrasound practice between July and August 2018. Clinical and surgical history, indication for TVS and TVS findings were documented. The prevalence of TVS‐confirmed POD obliteration, determined by interpretation of the sliding sign, was calculated for the entire cohort and for the subgroups of women with and without risk factors for endometriosis. High risk for endometriosis was defined as having (1) a TVS referral for endometriosis‐like pelvic pain or endometriosis specifically and/or (2) clinical symptoms or signs suggestive of endometriosis. Low risk was defined as the absence of these characteristics. Results During the study period, 1043 consecutive women underwent TVS. After excluding those who underwent transabdominal ultrasound, had a history of hysterectomy or with missing data, 909 women were analyzed. The prevalence of a negative sliding sign in the entire cohort was 47/909 (5.2%). A negative sliding sign was observed in 22/639 (3.4%) women with a low risk for endometriosis and 25/243 (10.3%) of those with a high risk for endometriosis (difference in proportions, 6.9% (95% CI 2.8–10.9%); P < 0.001). Conclusions We have demonstrated an overall prevalence of a negative sliding sign, suggesting POD obliteration, of 5.2% (or 1/20) in women seeking TVS for a gynecological indication. The prevalence of negative sliding sign in low‐risk women is not negligible (3.4% or 1/29 women). These women are most likely to have asymptomatic endometriosis or another important etiology of POD obliteration. The prevalence of a negative sliding sign is approximately three‐times higher in women with signs and/or symptoms of endometriosis (10.3% vs 3.4%). Copyright © 2020 ISUOG. Published by John Wiley & Sons Ltd.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Prevalence of negative sliding sign representing pouch of Douglas obliteration during pelvic transvaginal ultrasound for any indication

Leonardi

Martins

Espada

et al. 2020

Ultrasound in Obstet & Gyne

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“…According to our results, measurement of subcutaneous tissue stiffness has similar or higher sensitivity and lower specificity in predicting adhesions when compared to the two techniques mentioned above. 9,10,23 Thus, a SWE measurement of ≥36.5 kPa is a warning sign about adhesions for the surgical team. A more experienced surgical team could be prepared or the patient could be referred to a multidisciplinary center to reduce intraoperative complications in patients with high adhesion risk.…”

Section: Discussionmentioning

confidence: 99%

“…Therefore, many studies have been conducted to predict adhesions before a repeated CS. [5][6][7][8][9][10] Evaluation of the previous cesarean scar features (flat, depressed, elevated), scar pigmentation (non-pigmentation, hyperpigmentation), scar width and scar length have yielded conflicting results. [5][6][7][8] The absence of the free movement of the uterine anterior wall against the abdominal wall (sliding sign) on ultrasound is another sign of adhesions.…”

Section: Introductionmentioning

confidence: 99%

“…[5][6][7][8] The absence of the free movement of the uterine anterior wall against the abdominal wall (sliding sign) on ultrasound is another sign of adhesions. 9,10 However, the interpretation of this technique needs experience to reach a high rate of intra-observer and inter-observer reproducibility. 11 Elastography is a developing variation of ultrasound imaging that quantitatively measures the elasticity of the tissues.…”

Section: Introductionmentioning

confidence: 99%

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Subcutaneous tissue stiffness of cesarean incision scar by elastography as a predictor of intra‐abdominal adhesions

Seven

Yorgancı

Alkan

et al. 2020

J of Obstet and Gynaecol

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Aim: This study aimed to investigate whether subcutaneous tissue stiffness of the previous cesarean section (CS) skin incision could predict the severity of the intra-abdominal adhesions at a repeat CS. Methods: In this prospective cross-sectional study, pregnant women with at least one prior cesarean delivery were included. The subcutaneous tissue stiffness of the previous CS skin scar was measured by shear wave elastography (SWE) on the day of the repeat CS and the intra-abdominal adhesions were recorded by an adhesion classification scheme specific for CS. Total adhesion score was classified as mild adhesion between 1 and 4, moderate adhesion between 5 and 12, and severe adhesion if ≥13. Results: Of the 102 women, 41 (40.2%) had no adhesions, 18 (17.6%) had mild adhesions, 26 (25.5%) had moderate adhesions and 17 (16.7%) had severe adhesions. The mean SWE measurements were significantly higher in the moderate and severe adhesion group than the non-adhesion and mild adhesion group (51.5 AE 25.3 vs 36.8 AE 22.6, P = 0.003). There was a statistically significant correlation between the preoperative SWE measurements and total adhesion scores (correlation coefficient [r] = 0.397, P < 0.001). In receiveroperator characteristics curve analysis, the cutoff value for moderate or severe adhesions was found to be 36.5 (area under curve = 0.710, %95 confidence interval 0.606-0.815; P < 0.001). With the cutoff point of ≥36.5, the sensitivity and specificity for the prediction of mild and severe adhesions were 74.4% and 40.5%, respectively. Conclusion: Elastographic evaluation of the subcutaneous tissue stiffness of the cesarean incision scar might show the degree of intra-abdominal adhesions at a repeat CS.

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Difficulty in predicting intra‐abdominal adhesion before cesarean section: A case report

Suzuki

Wakaki

Watanabe

et al. 2022

Clinical Case Reports

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Sliding sign in third‐trimester sonographic evaluation of intra‐abdominal adhesions in women undergoing repeat Cesarean section: a novel technique

Cited by 23 publications

References 17 publications

Prevalence of negative sliding sign representing pouch of Douglas obliteration during pelvic transvaginal ultrasound for any indication

Prevalence of negative sliding sign representing pouch of Douglas obliteration during pelvic transvaginal ultrasound for any indication

Subcutaneous tissue stiffness of cesarean incision scar by elastography as a predictor of intra‐abdominal adhesions

Difficulty in predicting intra‐abdominal adhesion before cesarean section: A case report

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