Volume 24, Issue 105, September - October, 2020

Accuracy of sliding sign for prediction of adhesions in repeated cesarean section in third trimester and Intra-operative adhesion complications

Shirin Nirumanesh¹, Taraneh Arbabzadeh^2♦, Fatemeh Golshahi³, Maryam Moshfeghi⁴, Mahboobeh Shirazi⁵, Mamak Shariat⁶

¹Perinatalogist, Department of Obstetrics and Gynecology, Yas Women Hospital, Tehran University of Medical Sciences, Tehran, Iran.
²Perinatalogist, Department of fatal maternal medicine, Maternal, Fetal & Neonatal Research Center, Tehran University of Medical Science (TUMS), Tehran, Iran. ORCID: 0000-0003-0563-7177
³Perinatalogist, Maternal, Fetal & Neonatal Research Center, Tehran University of Medical Sciences, Tehran, Iran
⁴Perinatalogist, Royan Institute, Department of Endocrinology and Female Infertility, Reproductive Biomedicine Research Center, ACECR, Tehran, Iran
⁵Perinatalogist, Perinatology ward, Yas Hospital, Tehran University of Medical Sciences, Tehran, Iran
⁶Full Professor, Maternal, Fetal & Neonatal Research Center, Tehran University of Medical Sciences, Tehran, Iran

^♦Corresponding author
Perinatalogist, Department of fatal maternal medicine, Maternal, Fetal & Neonatal Research Center, Tehran University of Medical Science (TUMS), Tehran, Iran; Email: Taraneh_arbab@yahoo.com

ABSTRACT

Objective: Repeated cesarean sections (CS) are the common etiology of intra-abdominal adhesion formation with increased operating time and blood loss. Because of the necessity of a preoperative diagnosis, we decided to evaluate the sensitivity, specificity and predictive values of sliding sign in abdominal ultrasound in repeated CS for intra-abdominal adhesion diagnosis. Method: This study was performed on pregnant women with at least one previous CS in the third trimester. The movement of the outer surface of the myometrium relative to the inner surface of the abdominal fascia was evaluated by abdominal ultrasound for sliding sign. If the patient had sliding sign, the patient was low risk. In the absence of sliding sign, the patient was high risk. Then the questionnaire was filled out according to the CS findings and data was entered into analysis stage. Results: In the negative sliding sign group, the number of CS was higher than the positive sliding sign that was statistically significant (1.7 vs 1.4, p value=0.026). The higher the adhesion degree, the longer incision and delivery time and the lower 1-minute Apgar score (P = 0.0001). Of the 37 cases with adhesion, 25 did not have sliding sign, and the sensitivity was 68%. Of the 170 cases without adhesion, sliding was seen in 164 cases; with specificity 96.5% (positive and negative predicting values were 52% and 98%, respectively). Conclusion: Sliding sign by abdominal ultrasound could be an accurate and easy diagnostic tool in predicting intra-abdominal adhesion, especially in severe cases.

Keywords: repeated cesarean, intra-abdominal adhesion, sliding sign

Medical Science, 2020, 24(105), 3024-3034

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