Accuracy of Abdominal Striae Gravidarum, Scar Characteristics, and Pre-operative Sonographic Sliding Sign for Prediction of Intra-abdominal Adhesions in Pregnant Women with a History of Previous Cesarean Deliveries

Background & Objective: Intra-Abdominal Adhesions (IAA) are a common complication of prior Cesarean Delivery (CD) and may increase operative difficulty during repeat surgery. This study evaluated the diagnostic accuracy of abdominal striae gravidarum, scar characteristics, and the preoperative sonographic sliding sign for predicting IAA in women with a prior CD.Materials & Methods: This prospective cohort study included 180 women with one prior CD who underwent repeat CD at Rajavithi Hospital between September 2024 and July 2025. Striae gravidarum were graded using Davey’s scoring system, scar characteristics were assessed using a standardized scale, and the sliding sign was evaluated by transabdominal sonography. Surgeons, blinded to these assessments, evaluated IAA intraoperatively using the Peritoneal Adhesion Index (PAI), with PAI ≥ 6 indicating the presence of adhesions. Diagnostic accuracy was assessed using the area under the receiver operating characteristic Curve (AUC), sensitivity, specificity, Positive Predictive Value (PPV), and Negative Predictive Value (NPV) for each predictor and their combinations.Results: IAA were identified in 7.2% (13.180) of women undergoing repeat CD. Striae gravidarum showed the highest sensitivity (84.6%), while a negative sliding sign demonstrated the highest accuracy (AUC 0.807; NPV 97.5%). The Triple S Model showed superior discrimination (AUC 0.877; 95% CI, 0.784-0.970). At a cutoff score of 3, sensitivity and specificity were 84.6% and 82.6%, respectively, with a PPV of 27.5% and an NPV of 98.6%.Conclusion: The Triple S Model may be useful for ruling out intra-abdominal adhesions in women with prior cesarean delivery; however, its low PPV limits the identification of high-risk cases, and external validation is required before clinical implementation.