# Abdominal Striae, Cesarean Scar, and Ultrasound Sliding Sign as Predictors of Uterine Adhesions in Women Undergoing Repeat Cesarean Section

## TL;DR

This study identifies non-invasive predictors like abdominal striae, cesarean scar quality, and ultrasound findings that can help predict uterine adhesions in women undergoing repeat cesarean sections.

## Contribution

The study introduces a simple, non-invasive triad of predictors for uterine adhesions in repeat cesarean deliveries.

## Key findings

- A negative ultrasound sliding sign was strongly associated with adhesions (60.6% vs. 14.3%).
- Severe abdominal striae and higher Vancouver Scar Scale scores were linked to increased adhesion rates.
- The incidence of adhesions rose significantly with the number of previous cesarean sections.

## Abstract

Background

The escalating global cesarean section (CS) rate has led to a growing population undergoing repeat procedures, where postoperative adhesions are a major cause of surgical complications. Preoperative prediction of adhesions remains a significant challenge in obstetrics. This study aimed to evaluate the efficacy of non-invasive predictors - abdominal striae, previous CS scar characteristics, and the transabdominal ultrasound sliding sign - in forecasting intraoperative adhesions in women with a previous CS.

Methods

A prospective observational study was conducted among 155 pregnant women with at least one prior CS admitted for repeat cesarean delivery. Preoperatively, abdominal striae were graded using the Davey scoring system, and the previous CS scar was assessed using the Vancouver Scar Scale (VSS). A radiologist performed an ultrasound to determine the sliding sign. Intraoperative adhesion grading was performed using the Modified Tulandi and Lyell classification. Statistical analysis was done using Statistical Package for the Social Sciences (SPSS) version 23 (IBM Corp., Armonk, NY), with a p-value < 0.05 considered significant.

Results

Among the 155 participants, 68 (43.8%) had intra-abdominal adhesions, while 87 (56.2%) had none. The incidence of adhesions increased significantly with the number of previous CSs - 20 (26.7%) after one, 35 (51.5%) after two, and 13 (83.3%) after three or more CS (p = 0.007). A negative sliding sign was strongly associated with adhesions (60; 60.6%) compared to a positive sign (8; 14.3%, p < 0.001). Similarly, severe striae were linked to a higher adhesion rate (56; 62.9%, p < 0.001), and VSS >4 indicated significantly more adhesions (54; 58.1%, p < 0.001).

Conclusion

The study concludes that the preoperative assessment of abdominal striae, previous cesarean scar quality, and the ultrasound sliding sign provides a simple, non-invasive, and effective triad for predicting uterine adhesions. Integrating these markers into clinical practice can enhance preoperative risk stratification, optimize surgical planning, and improve patient safety during repeat CSs.