A simple sonographic marker ‘sliding sign’ of the uterus during the last trimester of pregnancy can help physicians to distinguish between patients who have a high probability of intraabdominal adhesions during repeat cesarean section reports the results of an observational study published in the Journal of Ultrasound in Obstetrics & Gynecology (UOG).
Presence of Intra-abdominal adhesions complicate the repeat surgical procedure and increase the chances of bladder and bowel trauma and bleeding. About 24% to 46% of patients will develop adhesions after one cesarean and the rate increases to 43% to 75% at the third, and up to 83% at the fourth cesarean delivery.
Italian researcher Baron and colleagues selected 59 patients who had a history of one or more previous cesarean section and evaluated them during the third trimester of ongoing pregnancy by abdominal ultrasound. To know about the risk of the presence of adhesions, the researcher looked at the sliding of gravid uterus under the inner part of the fascia of abdominal muscles.
Women who demonstrated easy and obvious sliding during deep breathing were predicted to be at low to moderate risk of the presence of intraabdominal adhesions (positive sliding sign), while in women whom the sliding was very little or absent (negative sliding sign), were at high risk of severe adhesions.
The prediction was confirmed at surgery, 16 out of 19 women who displayed a negative ‘sliding sign’ had severe intra-abdominal adhesions while 35 out of 40 women with positive ‘sliding sign’ had very few adhesions.
The sensitivity and specificity of the sliding sign in predicting the presence of intra‐abdominal adhesions in women undergoing repeat CS were 76.2% and 92.1%, respectively.
Thus, a simple sonographic sign can help physicians to know about the patient’s risk of having adhesions and be prepared for adhesions related complications during the repeat cesarean delivery.
Here is UOGJournal video clip illustrating the simple sonographic marker ‘sliding sign.’
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