The value of sliding sign in evaluation of intra-abdominal adhesions in pregnant women undergoing elective cesarean section | ||||
| The Egyptian Journal of Fertility of Sterility | ||||
| Article 7, Volume 27, Issue 4 - Serial Number 11106352, July 2023, Page 55-64 PDF (798.32 K) | ||||
| Document Type: Original Article | ||||
| DOI: 10.21608/egyfs.2023.317678 | ||||
 View on SCiNiTO | ||||
| Authors | ||||
Doaa Shafie Belal  1; Mohamed Ismaeil Albokl2; Ahmed Shaaban Sayed Hassan3; Nada Kamal4
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| 1Department of Obstetrics and Gynecology, Cairo University, Alsaraya Street, Kasr Al Ainy, Cairo, Egypt | ||||
| 2Professor Ob & Gyn, Cairo University | ||||
| 3Assistant Lecturer Ob & Gyn, Cairo University | ||||
| 4Lecturer Ob & Gyn, Cairo University | ||||
| Abstract | ||||
| Background: Incident of adhesions is a common and serious post-operative complication. Pre-operative prediction of adhesions is essential to help the surgical team in better counseling and preparation. Yet, the pre-operative assessment of adhesions is lacking. The sonographic sliding movement gives a reflection of the free mobility of the underlying viscera, hence; can predict the presence or absence of adhesions. Objective: To study the accuracy of U/S sliding sign in pre-operative prediction of adhesions, in pregnant patients prior to CS procedure in general, and to re-adjust this data among different BMI classes in particular. Methodology: A prospective, double-blinded study that included 235 pregnant patients at term, who were candidates for elective CS at Kasr Al-Ainy Hospital, Cairo University. We documented the type of previous surgery done. A single sonographer recorded the sliding sign pre-operatively. The surgeons reported the degree of adhesions quantitatively, according to a scoring system. Moreover, we documented the operative delivery time (time from skin incision to time of fetal delivery), and the incidence of visceral injury. Data was further re-analyzed in reference to each BMI class individually. Results: : A total number of 235 pregnant women were recruited, with a mean age; 30 years, and mean BMI; 29kg/m2. The prevalence of adhesions was 48.51% (19.15% mild, and 29.36% marked adhesions). 0.85% of the cases had visceral injury. The prevalence of adhesions increased with the increase in number of previous CS; 22.8%, 34.2%, and 43% in cases with previous one, two, three or more CS respectively. 68.51% (n=161) of the recruited patients had positive sliding sign, while 31.49 % (n=74) had negative sliding sign. Positive sliding sign correctly identified 152 out of 166 patients who had no or mild adhesions, while negative sliding sign correctly identified 60 out of 66 patients who had marked adhesions. Accordingly, the sensitivity, specificity, PPV, NPV and accuracy of sliding sign in predicting intra-operative adhesions were 86.96%, 94.41%, 81.08%, 94.41% and 90.21% respectively. We further re-analyzed the data in relation to different BMI classes. The sensitivity, specificity, PPV, NPV, and accuracy specific to each BMI group were; 94.12%, 96.08%, 88.89%, 98%, 95.59% respectively in the normal weight group (n=68); 90%, 93.62%, 85.71%, 95.65%, 92.54% respectively in overweight cases (n=67); and finally, 81.25%, 86.76%, 74.29%, 90.77%, 85% respectively in the obese group (n=100). The median operative delivery time was significantly longer in patients with negative sliding sign compared to those with positive sliding sign (18.9 minutes versus 11 minutes). Conclusion: The pre-operative assessment of the sliding sign is useful in the prediction of intra-abdominal adhesions, prior to CS procedure, especially in normal weight and overweight cases. The negative sliding sign correlates with longer operative delivery time. | ||||
| Keywords | ||||
| Keywords: adhesions; sliding sign; cesarean section; body mass index | ||||
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