# Predicting the Presence of Intra-abdominal Adhesions in Pregnant Women Undergoing a Repeat Cesarean Section by Assessing the Ultrasound Sliding Sign: A Prospective Observational Study

## TL;DR

This study shows that an ultrasound sliding sign can reliably predict intra-abdominal adhesions in pregnant women undergoing repeat cesarean sections.

## Contribution

The study provides new evidence on the diagnostic accuracy of the ultrasound sliding sign for adhesion prediction in repeat cesarean cases.

## Key findings

- The ultrasound sliding sign had 86.1% sensitivity and 85.8% specificity for predicting adhesions.
- Adhesions were significantly linked to age over 30, higher BMI, and multiple previous cesareans.
- The sliding sign's high negative predictive value (91.6%) supports its use in clinical decision-making.

## Abstract

Background

Cesarean 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.

Methodology

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 SPSS version 26 (IBM Corp., Armonk, NY, USA).

Results

Among the participants, 40% had adhesions. The ultrasound sliding sign demonstrated 86.1% sensitivity, 85.8% specificity, 77.5% positive predictive value, and 91.6% negative predictive value. Adhesions were significantly associated with maternal age (>30 years), parity (≥2), higher body mass index, and multiple previous CSs.

Conclusions

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