 |
| 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.
