Negative sliding sign by ultrasound in repeat cesarean section predicts presence of severe intrabdominal adhesions

Photo courtesy: YouTube video clip by Green Journal

A negative sliding sign by ultrasonography (USG) in patients with previous cesarean section helps alert the surgeon to expect massive intraabdominal adhesions, difficult repeat cesarean section and need of blood transfusion during surgery reports the results of a prospective observational study published ahead of print in the February issue of Journal Obstetrics and Gynecology.

Postoperative adhesion formation is quite prevalent after an abdominal or pelvic surgery and any method which can predict the existence of such adhesion could optimize the outcome of current surgery.

Real-time ultrasound-based technique of ‘slide test’ is the non-invasive way of detecting pelvic and intrabdominal adhesions preoperatively. The test measures the relative motion between abdominal and uterine wall.

The researchers recruited 370 women with previous cesarean section. The women underwent transabdominal sonography and a video-clip was recorded at deep inspiration in sagittal plane lateral to the midline.

The findings of preoperative ultrasonography were correlated with adhesions found during surgery by surgeons who were not aware about the preop USG findings.

Statistical analysis of these findings showed that when less or no movement was detected between the uterus and abdominal wall (negative ‘slide test’), it correctly identified patients with severe adhesion in 56% of cases (sensitivity 56%, 95% CI 35–76). It also predicted absence of severe adhesions correctly in 95% of patients (specificity 95%, 95% CI 93–97).

When the USG findings was combined with history of adhesions in previous surgery, severe adhesions were correctly predicted in 64% of patients and absence of adhesions was predicted in 94% of patients.

The surgeons noted a longer delivery time and significant blood loss in patients with negative sliding sign.

Thus, it was seen that ‘slide test’ is a simple, reliable and non-invasive screening test in repeat cesarean cases to predict technical difficulty during surgery.

Here is a short video of visceral slide test from video gallery of Journal Obstetrics and Gynecology.

This short video clip explains the equipment needed, how to perform, and how to interpret the visceral slide test. An example of a normal test and an abnormal ultrasound visceral slide test are illustrated, including a laparoscopic view of the patient with an abnormal test.

Video courtesy of Erica C. Dun, MD, MPH.

 Abstract