The value of sliding sign in evaluation of intra-abdominal adhesions in pregnant women undergoing elective cesarean section

Background: Incident of adhesions is a common and serious post-operative complication. Pre-operative prediction of adhesions is essential to help the surgical team in better counseling and preparation. Yet, the pre-operative assessment of adhesions is lacking. The free mobility of the underlying viscera, hence; can predict the presence or absence of adhesions. Objective: To study the accuracy of U/S sliding sign in pre-operative prediction of adhesions, in pregnant patients prior to CS procedure in general, and to re-adjust this data among different BMI classes in particular. Methodology: A prospective, double-blinded study that included 235 pregnant patients at term, who were candidates for elective CS at Kasr Al-Ainy Hospital, Cairo University. We documented the type of previous surgery done. A single sonographer recorded the sliding sign pre-operatively. The surgeons reported the degree of adhesions quantitatively, according to a scoring system. Moreover, we documented the operative delivery time (time from skin incision to time of fetal delivery), and the incidence of visceral injury. Data was further re-analyzed in reference to each BMI class individually. Results: : A total number of 235 pregnant women were recruited, with a mean age; 30 years, and mean BMI; 29kg/m2. The prevalence of adhesions was 48.51% (19.15% mild, and 29.36% marked adhesions). 0.85% of the cases had visceral injury. The prevalence of adhesions increased with the increase in number of previous CS; 22.8%, 34.2%, and 43% in cases with previous one, two, three or more CS respectively. 68.51% (n=161) of the recruited patients had positive sliding sign, while 31.49 % (n=74) had negative sliding sign. Positive sliding sign or mild