Abstract
Objective: To evaluate and compare the diagnostic accuracy of the negative sliding sign technique, when using abdominal and transvaginal ultrasound, in predicting intra-abdominal uterine adhesions in pregnant women with a history of previous cesarean section.
Methods: This prospective multi-center study was conducted in Qaem and Imam Reza hospitals, Mashhad, Iran during 2020-2021. Participants were pregnant women (36 weeks or more) with a history of at least one cesarean section who were candidates for elective cesarean. Abdominal and transvaginal ultrasound examinations were performed using deep breath technique recruitment and the presence of sliding sign was assessed. Subsequently, at surgery uterine adhesion and its degree were evaluated. To prevent bias, surgeons were blinded to the ultrasound scan results, and the sonographer was blinded to the surgical findings. Data were analyzed using IBM SPSS Statistics v.26 (IBM Corp., Armonk, NY, USA).
Results: A negative sliding sign using the transvaginal ultrasound method showed an overall sensitivity of 57.7%, specificity of 97.9%, positive likelihood ratio (LR) of 27.6, negative LR of 0.4, positive predictive value (PPV) of 93.8% and a negative predictive value (NPV) of 81% in the prediction of uterine adhesion. The abdominal ultrasound method displayed an overall sensitivity of 78.6%, specificity of 80%, positive LR of 3.93, negative LR of 0.1, PPV of 47.8% and a NPV of 94.1%.
Conclusion: The findings of this study indicate that the use of the sliding sign technique with deep breath technique upon transvaginal and abdominal ultrasound methods can both accurately predict intra-abdominal uterine adhesions in pregnant women with a history of previous cesarean sections.
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Copyright (c) 2023 Salmeh Dadgar, Sara Mirzaeian, Monavavvar Afzalaghaee, Roya Jalali, Neda Davaryari