What question did this study set out to answer?

This study aims to assess the accuracy of the sliding sign on ultrasound for predicting adhesions in repeat cesarean sections and its impact on surgery outcomes.

March 22, 2026Open Access

Preoperative Sliding Sign as a Predictor of Intraoperative Adhesions and Surgical Outcomes in Repeat Cesarean Sections: A Cross-sectional Study

Key Points

This study aims to assess the accuracy of the sliding sign on ultrasound for predicting adhesions in repeat cesarean sections and its impact on surgery outcomes.
Conducted as a cross-sectional study with 100 pregnant women undergoing repeat cesarean sections.
Ultrasound sliding sign assessed preoperatively and classified based on movement.
Intraoperative adhesions graded into no/mild, moderate, or severe.
Surgical outcomes like operative time, hemoglobin drop, and visceral injury were analyzed.
Diagnostic performance metrics of the sliding sign were calculated.
43% of patients exhibited adhesions, categorized as 15% mild, 19% moderate, and 9% severe.
A sliding sign of <1 cm predicted severe adhesions with 100% sensitivity and 98.9% specificity.
Free movement >2 cm accurately indicated absence of significant adhesions with 100% sensitivity.
Patients with restricted sliding signs had longer operative times, greater hemoglobin drops, and higher visceral injury rates, all statistically significant.

Abstract

Background: Adhesions during repeat cesarean sections increase surgical difficulty, risk of visceral injury, operative time, and blood loss.A reliable, non-invasive method to predict adhesions preoperatively can improve surgical planning and outcomes.Objectives: To evaluate the diagnostic accuracy of the ultrasound-based sliding sign in predicting the presence and severity of intraoperative adhesions in repeat cesarean sections and its association with surgical outcomes.Materials and methods: This cross-sectional study was conducted over one year (June 2023-May 2024) at Sawai Man Singh Medical College, Jaipur, including 100 pregnant women undergoing repeat cesarean section.The uterine sliding sign was assessed preoperatively via transabdominal ultrasound and categorized as: >2 cm, 1-2 cm, or 2 cm predicted the absence of significant adhesions with 100% sensitivity, 98.9% specificity, 97.2% PPV, and 100% NPV.Patients with restricted or absent sliding sign had significantly longer operative times (63.00 3.50 min), greater hemoglobin drop (1.21 0.26 gm/dL), and higher visceral injury rates (50%) (p < 0.001). Conclusion:The sliding sign is a simple, non-invasive, and highly accurate tool for predicting intraoperative adhesions in repeat cesarean sections, aiding in surgical preparedness.Clinical significance: Routine use of the ultrasound sliding sign in preoperative assessment can enhance safety and guide operative planning in repeat cesarean sections.

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Cite This Study

Jain et al. (Fri,) studied this question.

synapsesocial.com/papers/69bf86ecf665edcd009e9164 https://doi.org/https://doi.org/10.5005/jp-journals-10006-2832

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