Diagnostic utility of the ultrasound sliding sign in predicting intra-abdominal adhesions in repeat caesarean delivery: a prospective study.

Background: Intra-abdominal adhesions following caesarean sections pose significant challenges during repeat surgeries, leading to increased maternal morbidity. A reliable, non-invasive preoperative diagnostic tool such as the ultrasound (USG) sliding sign may help predict adhesions and improve surgical preparedness.

Objectives: To evaluate the diagnostic accuracy of the ultrasound sliding sign in predicting intra-abdominal adhesions in women undergoing repeat lower segment caesarean section (LSCS), and to correlate sonographic findings with intraoperative adhesion severity.

Methods: This prospective observational study was conducted on 250 pregnant women with a history of one or more previous LSCS. All participants underwent preoperative transabdominal ultrasound to assess the presence or absence of the sliding sign. Adhesion severity was classified intraoperatively using the Nair classification. Associations between adhesion severity and clinical variables such as age, BMI, number of previous LSCS, and gestational age were analysed using chi-square and ANOVA tests.

Results: A significant association was observed between the absence of the USG sliding sign and the presence of moderate to severe adhesions (p < 0.001). The sliding sign demonstrated a sensitivity of 72.88%, specificity of 85.86%, positive predictive value of 61.43%, and negative predictive value of 91.11% and an overall accuracy of 82.8%. The receiver operating characteristic (ROC) curve analysis showed an area under the curve (AUC) of 0.96, indicating excellent diagnostic accuracy. Mean intraoperative blood loss and time from skin incision to delivery significantly increased with higher adhesion grades (p < 0.001). A statistically significant correlation was also noted between the number of previous LSCS and adhesion severity (p = 0.022), whereas age, BMI, gestational age, and place of previous delivery were not significantly associated.

Conclusion: The ultrasound sliding sign is a simple, non-invasive, and effective tool for the preoperative prediction of intra-abdominal adhesions in women undergoing repeat caesarean sections. Its use may aid in surgical planning and reduce operative complications.