Sliding Sign in Third-Trimester Ultrasound Evaluation of Intra-Abdominal Adhesions in Women Undergoing Repeat Cesarean Section

Document Type : Original Article

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Department of Obstetrics and Gynecology, Faculty of Medicine, Ain Shams University, Egypt

Abstract

Background: Adhesions are the most frequent complication following abdominal and pelvic surgery, developing after more than 90% of interventions concerning the abdominal cavity. Post cesarean section adhesions are a major complication in subsequent surgeries, causing an increased risk for bladder and bowel injury (0.1–0.3%), hemorrhage (0.1–1.4%), infection (0.4–1.6%) and even hysterectomy (0.1–1.4%).
Aim of the Work: To predict the intra-abdominal adhesions in the third trimester of pregnancy in women undergoing repeated CS by the sliding sign marker using trans-abdominal ultrasound.
Patients and Methods: This prospective double blinded observational study was conducted at tertiary care hospital at Ain shams University Maternity Hospital from October 2022 till June 2023 and performed on total 200 patients who underwent elective CS .
Results: Mean ±SD of Previous CS was 1.9±1.0. Mean ±SD of Operation duration was 59.4±10.3, with range 39.0–83.0. Mean ±SD of Blood loss was 366.0±87.1, with range 200.0–650.0. Bladder injury and Intestinal injury were reported in 2.0% and 0.5% respectively. Adhesions was found in less than half of the studied cases. Minimal grade was the most frequent.
Conclusion: The real-time dynamic transabdominal ultrasound sliding sign is a non-invasive, well-tolerated technique. Its preoperative analysis in patients who have had previous abdominopelvic surgery may help to evaluate the risk of bowel or bladder injury and the complexity of the planned intervention, improving the safety of surgery, and may help to inform the anesthesiologist regarding the expected duration of the intervention and any potential complications during the procedure.

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