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

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 <1 cm/no movement.Adhesions were graded intraoperatively as no/mild, moderate, or severe.Surgical outcomes, including operative time, hemoglobin drop, and visceral injury, were analyzed.Diagnostic performance of the sliding sign was calculated.Results: Adhesions were noted in 43% of patients (15% mild, 19% moderate, and 9% severe).A sliding sign of <1 cm or absent predicted severe adhesions with 100% sensitivity, 98.9% specificity, 90% positive predictive value (PPV), and 100% negative predictive value (NPV).Free movement >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.