Ultrasonography Sliding Sign as a Predictor for Intraabdominal Adhesions in Repeated Cesarean Deliveries: Retrospective Cohort Study

Abstract

Background: Our objective was to evaluate the ultrasonography sliding sign with enhanced reliability using an interobserver approach, with the aim of predicting standardized intra-abdominal adhesions before cesarean section. Methods: Between January 2022 and January 2024, this retrospective cohort study included 350 individuals who underwent cesarean section. Data from 198 participants who met the inclusion criteria were analyzed. Analyzes were made with SPSS 26.0. The Mann-Whitney Uitest was employed to assess variables that were not normallyidistributed. Chi-squareitest and Fisheriprecision test were employed in the categoricalidata analysis. These were presented as counts and percentages (%). An inter-rater reliability analysis was performed for ultrasonography sliding sign finding. For this purpose, the Cohen’s Kappa was calculated. Receiver operatingicharacteristic analysis was used to determine the area under theicurve, which indicates the average sensitivity of ultrasonography sliding sign finding. There was a 95% confidenceiinterval for the results. A p-value of less than 0.05 was deemedistatistically significant. To assess slidingxsigns, all pregnant participants received transabdominalxultrasonography. The study achieved triple blinding: both sonographers were blinded to surgical findings, the surgeon remained blinded to ultrasound findings, and the data analyst was blinded to both sonographic and surgical findings. According to the Nair's modified scoringisystem, the cases were classified as Group 1 (Adhesions present [Grade ≥ 1]; n=107, 54%) and Group 2 (No adhesions [Grade 0]; n=91, 46%). Results: The diagnostic value of transabdominal ultrasonography sliding sign for detecting the presence of intra-abdominaliadhesion (according to the Modified Nair’s Scoring system) yielded a 84.6% specificity and 58.9% sensitivity. A Nair's score ≥2 was identified as the cut-off point, with the sliding sign finding being statistically significant, resulting in a 70% specificity and 54% sensitivity. Conclusion: This research validates the use of a sliding sign during transabdominal ultrasonography in pre-cesarean evaluation in patients with previous cesarean section. It has been shown that applying the adhesion scoring system categorically as well as using it numerically makes a difference by analyzing the cut-off point of Nair's score as 2. From this perspective, the reliability of the sliding sign finding in transabdominal ultrasound will be better demonstrated.