Transabdominal sonographic sliding signs for preoperative prediction of dense intra-abdominal adhesions in women undergoing repeat Cesarean delivery.

IF 6.1 1区 医学 Q1 ACOUSTICS
Ultrasound in Obstetrics & Gynecology Pub Date : 2024-12-01 Epub Date: 2024-11-12 DOI:10.1002/uog.29133
M Mayibenye, G A B Buga, M L Mdaka, M K Nanjoh
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引用次数: 0

Abstract

Objectives: To assess the accuracy and utility of transabdominal sonographic paraumbilical and suprapubic sliding signs in predicting intra-abdominal adhesions in women undergoing repeat Cesarean section (CS), and to investigate the association of repeat CS with short-term maternal and neonatal outcomes.

Methods: This was a prospective observational study of pregnant women with a history of CS who were scheduled for third-trimester elective or emergency CS at a tertiary referral and teaching hospital between July 2021 and June 2022. In order to evaluate the role of transabdominal sonographic paraumbilical and suprapubic sliding signs in the prediction of intra-abdominal adhesions, participants underwent a high-resolution transabdominal ultrasound scan prior to repeat CS. Free cephalad and caudad gliding of the uterus under the abdominal wall during deep inhalation and exhalation in each area was considered a positive sliding sign, suggesting a low risk of intra-abdominal adhesions. The absence of such movement was considered a negative sliding sign, suggesting a high risk of intra-abdominal adhesions. The presence or absence of intra-abdominal adhesions was then confirmed during surgery by physicians who were blinded to the sonographic sliding-sign findings. The type of adhesion, structures involved, method of adhesiolysis, incision-to-delivery time, 1-min and 5-min Apgar scores, maternal and neonatal injury and other short-term complications were also reported.

Results: Of 419 women with a history of at least one previous CS who underwent repeat CS, the preoperative sonographic paraumbilical and suprapubic sliding signs were negative in 173 (41.3%) and 178 (42.5%) women, respectively. On repeat CS, 224 (53.5%) women had intra-abdominal adhesions, of which 165 (39.4%) had dense adhesions and 59 (14.1%) had only filmy adhesions. The sensitivity and specificity of a negative preoperative paraumbilical sliding sign in predicting the presence of dense intra-abdominal adhesions in women undergoing repeat CS were 94.6% (95% CI, 92.4-96.7%) and 93.3% (95% CI, 90.9-95.7%), respectively. A negative suprapubic sliding sign also showed high sensitivity (95.2% (95% CI, 93.1-97.2%)) and specificity (91.7% (95% CI, 89.1-94.4%)). Additionally, a negative sliding sign at both locations in the same patient had robust sensitivity (90.2% (95% CI, 87.3-93.0%)) and specificity (96.3% (95% CI, 94.5-98.1%)). We found that the risk of dense intra-abdominal adhesions increased with parity and the number of previous CS. Dense intra-abdominal adhesions were associated with increased incision-to-delivery time, higher risk of maternal bladder injury, intraoperative bleeding and postpartum hemorrhage.

Conclusions: Dense intra-abdominal adhesions are common in women with a history of CS and are associated with delayed delivery of the neonate and increased risk of adverse maternal outcomes. The transabdominal sonographic paraumbilical and suprapubic sliding signs are robust methods for the accurate preoperative prediction of dense intra-abdominal adhesions in patients with a history of CS. As the techniques are easy to learn and perform, the sliding sign should be used more widely for triaging patients at high risk of dense intra-abdominal adhesions for appropriate preoperative planning. © 2024 International Society of Ultrasound in Obstetrics and Gynecology.

经腹超声滑动征象用于术前预测再次剖宫产产妇腹腔内的致密粘连。
目的评估经腹超声脐旁和耻骨上滑动征预测再次剖宫产(CS)妇女腹腔内粘连的准确性和实用性,以及再次剖宫产与短期孕产妇和新生儿结局的关联:这是一项前瞻性观察研究,研究对象是2021年7月至2022年6月期间在一家三级转诊和教学医院计划进行第三孕期择期或急诊剖宫产的有剖宫产史的孕妇。为了评估经腹超声脐旁和耻骨上滑动征象在预测腹腔内粘连中的作用,参与者在再次CS前接受了高分辨率经腹超声扫描。在每个区域深吸气和呼气时,子宫在腹壁下的头侧和尾侧自由滑动被视为阳性滑动征象,表明腹腔内粘连的风险较低。没有这种移动被视为阴性滑动信号,表明腹腔内粘连的风险很高。腹腔内粘连的存在与否在手术过程中由对超声滑动信号结果保密的医生进行确认。此外,还报告了粘连类型、涉及结构、粘连溶解方法、切口到分娩时间、1 分钟和 5 分钟 Apgar 评分、产妇和新生儿损伤及其他短期并发症:结果:在 419 名既往至少有过一次剖宫产史并再次进行剖宫产的产妇中,术前声像图脐带旁和耻骨上滑动征阴性的产妇分别为 173 人(41.3%)和 178 人(42.5%)。在再次进行腹腔镜手术时,224 名(53.5%)女性腹腔内有粘连,其中 165 名(39.4%)有致密粘连,59 名(14.1%)仅有丝状粘连。术前脐旁滑动征阴性对预测再次进行CS的女性腹腔内出现致密粘连的敏感性和特异性分别为94.6%(95% CI,92.4-96.7%)和93.3%(95% CI,90.9-95.7%)。耻骨上滑动征阴性的敏感性(95.2% (95% CI, 93.1-97.2%))和特异性(91.7% (95% CI, 89.1-94.4%))也很高。此外,同一患者两个位置的滑动征均为阴性也具有很高的灵敏度(90.2% (95% CI, 87.3-93.0%))和特异性(96.3% (95% CI, 94.5-98.1%))。我们发现,腹腔内致密粘连的风险随胎次和前次 CS 的次数而增加。腹腔内密集粘连与从切口到分娩的时间延长、产妇膀胱损伤、术中出血和产后出血的风险升高有关:腹腔内粘连致密在既往有 CS 史的产妇中很常见,与新生儿分娩延迟和产妇不良预后风险增加有关。经腹超声脐旁征象和耻骨上滑动征象是准确预测有 CS 史患者术前腹腔内致密粘连的可靠方法。由于该技术易学易用,滑动征应更广泛地用于腹腔内高密度粘连高风险患者的分流,以制定适当的术前计划。© 2024 国际妇产科超声学会。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
CiteScore
12.30
自引率
14.10%
发文量
891
审稿时长
1 months
期刊介绍: Ultrasound in Obstetrics & Gynecology (UOG) is the official journal of the International Society of Ultrasound in Obstetrics and Gynecology (ISUOG) and is considered the foremost international peer-reviewed journal in the field. It publishes cutting-edge research that is highly relevant to clinical practice, which includes guidelines, expert commentaries, consensus statements, original articles, and systematic reviews. UOG is widely recognized and included in prominent abstract and indexing databases such as Index Medicus and Current Contents.
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