Sliding Sign in Late Trimester Ultrasound Evaluation of Intra-abdominal Adhesions in Women Undergoing Repeat CS
Condition: Cesarean Section Complications
MeSH terms: Tissue Adhesions
Study type: Observational

Summary: 
      Predicting the presence of severe adhesions may also assist clinically in several ways:
      first, it allows allocation of more complicated surgeries to experienced surgeons; second,
      the surgeons can plan and prepare better for the surgery if they know in advance whether they
      are going to operate a complicated surgery; third, a difficult surgery may be scheduled to be
      performed in an experienced center, preparing cross match blood units, and alerting the
      general surgeon and urologist of the potential risk for surgical complications, saving time
      if intervention is required.

      This information can permit preoperative planning by a multidisciplinary team of surgeons and
      allow the patient to be informed of the potentially high risk of complications.
    

Detailed description: 
      The incidence of repeat cesarean delivery is on the rise worldwide, approximately 90% of
      women with a prior cesarean delivery undergo a planned repeat cesarean delivery in their next
      pregnancy.

      Post-cesarean 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%).

      In addition to the risk associated with the pelviabdominal surgical procedure itself,
      adhesiolysis may result in injury to adjacent viscera, blood loss, and in case of emergency
      cesarean delivery, to the perinatal adverse outcome associated with delayed delivery of the
      neonate. This represents a considerable healthcare issue, as it has a significant impact both
      on the patient, increasing morbidity and mortality, and on healthcare costs. It is therefore
      important for surgeons to detect patients at high risk of having adhesions.

      Women suspected to have severe intra-abdominal adhesions may benefit from appropriate
      preparation of blood products, better assignment of surgeons, request for preoperative
      surgical assistance of other medical specialties, and possibly performance of a midline skin
      incision to enter the peritoneal cavity. It is therefore important for surgeons to detect
      patients at high risk of having adhesions.

      Various means have been proposed to predict adhesions prior to surgery, including analysis of
      patient characteristics and appearance of the scar, as well as the intraoperative peritoneal
      adhesion index.
    

Intervention name(s): Sliding sign
Intervention type(s): Other
Intervention description(s): All women had Transabdominal Ultra-sonography using SAMSUNG WS80 "elite" ultrasound machine during the preoperative examination, using the real-time Transabdominal pelvic features (the relative motion between the maternal abdominal and uterine wall).
The patient was asked to breathe deeply, accentuating her respiratory movements and the sonographer recorded a video clip in a mid-sagittal plane lateral to umbilicus focus on the infra-umbilical space, to determine whether the structure glided freely in relation to adjacent structures. To be considered as sliding, the structures had to glide easily, one against the other (positive sliding sign); no motion of the structure in question signaled a negative sliding sign.
Observational model: Cohort
Time perspective: Prospective
Sampling method: Probability Sample
Study population: 
        All third trimester pregnant women with a history of previous cesarean section who were
        admitted for elective caesarian section had Transabdominal Ultra-sound during the
        preoperative examination, using the real-time Transabdominal ultrasound pelvic features