Association of Intra-Abdominal Adhesions with Ultrasonographic Sliding Sign in Third Trimester Women Prior to a Repeated Cesarean Section

Abstract Background Adhesions are the most frequent complication following abdominal and pelvic surgery, developing after more than 90% of interventions concerning the abdominal cavity. Consequences include infertility, chronic pelvic pain and small bowel obstruction. Adhesions increase the complexity of future surgery by increasing the risk of urinary tract and intestinal injury, and by increasing the operative duration and thus the risk of blood loss. Objective To evaluate the efficiency of preoperative transabdominal ultrasonographic features in prediction of intra-abdominal adhesions in pregnant women during third-trimester with history of previous cesarean section surgery scheduled for a planned repeated elective C.S. delivery. Methods After ethical committee approval and informed consent from the patients, this prospective study was performed on total 200 third-trimesteric pregnant women with history of previous cesarean section who admitted for elective caesarian section and willing to participate in the study to investigate the value of the sonographic evaluation in predicting the intra-abdominal adhesions at tertiary care hospital at Ain Shams University Maternity Hospital from January 2023 till October 2023 and performed on total 200 patients who underwent elective caesarean delivery. Results The findings of our study demonstrated a good capability of a simple third-trimester transabdominal sonographic sign, the absence of sliding of the uterus, to predict the presence of intra-abdominal adhesions in women undergoing repeat CS. Conclusion We concluded that 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.