Predicting the presence of intra abdominal adhesions in pregnant women undergoing repeat caesarean section by assessing ultrasound sliding sign. A prospective observational study

Abstract

BACKGROUND AND OBJECTIVE: Caesarean section (CS) is a common obstetric procedure, with repeat CS increasing the risk of intra-abdominal adhesions, leading to surgical complications. The ultrasound sliding sign has been proposed as a non-invasive tool to predict adhesions, but its diagnostic accuracy remains under evaluation. This study aims to assess the accuracy of the ultrasound sliding sign in predicting intra-abdominal adhesions in repeat CS cases and evaluate its correlation with intraoperative findings.

MATERIAL AND METHODS: A prospective observational study was conducted at BLDE (D.U) Shri B.M. Patil Medical College from May 2023 to December 2024, including 200 women undergoing repeat CS. Preoperative ultrasound evaluated the sliding sign, classifying cases as positive (free uterine movement, no adhesions) or negative (restricted movement, adhesions). Intraoperative findings were recorded for correlation. Statistical analysis was performed using IBM SPSS (Version 20).

RESULTS: Among the participants, 40% had adhesions. The ultrasound sliding sign demonstrated 86.1% sensitivity, 85.8% specificity, 77.5% PPV, and 91.6% NPV. Adhesions were significantly associated with maternal age (>30 years), parity (≥2), higher BMI, and multiple previous CS. ROC analysis confirmed the strong predictive value of the sliding sign.

CONCLUSION: The ultrasound sliding sign is a reliable, non-invasive tool for predicting intraabdominal adhesions in repeat CS, aiding in surgical preparedness. Given its high diagnostic accuracy, it can enhance clinical decision-making, but further studies are needed to refine its application.