OC08.05: Prediction of intra‐abdominal adhesions from previous Caesarean delivery based on a combination of sonographic features and scar and striae assessment

This study aims to determine the predictive value of individual markers and combinations of the ultrasonographic sliding sign, de-novo ultrasound morphologies, scar appearance, and striae gravidarum in preoperatively predicting intra-abdominal adhesions in repeated Caesarean delivery. This prospective, double-blind study included 122 singleton pregnant women with a history of Caesarean delivery. Presurgical assessments comprised transabdominal ultrasound to evaluate the sliding sign, uterine muscle thickness, bladder appearance, bladder angle, and the bladder dome–cervix distance, along with scar and striae characteristics. Surgical observations were made to identify intra-abdominal adhesions and evaluate maternal and fetal outcomes. The correlations of each marker with severe adhesion were calculated, and their accuracy, as well as the combined test performance, was assessed. Severe adhesions were present in 10.8% (13/122) of the cases. For predicting severe adhesions, a negative uterine sliding sign (RR 12.93 [95% CI 3.64–45.97], p < 0.001) and uterine muscle thickness ≥ 0.6cm (RR 3.40 [95% CI 1.04–11.10], p = 0.035) were statistically significant. The negative uterine sliding sign showed 61.54% sensitivity, 88.89% specificity, 40.00% negative predictive value, and 95.10% positive predictive value. The cut-off point of uterine muscle thickness with appropriate sensitivity (46.15–61.54%) and specificity (60.55–79.82%) was 0.51–0.60cm. The combination of these two markers yielded the highest specificity (97.25%) and positive likelihood ratio (11.19). However, other sonographic characteristics, striae gravidarum, and scar features did not significantly predict severe adhesions. A negative uterine sliding sign and uterine muscle thickness ≥ 0.6cm were significant predictors of severe intra-abdominal adhesion in repeated Caesarean section.