{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,27]],"date-time":"2026-08-27T04:44:18Z","timestamp":1787805858567,"version":"build-2784847793"},"reference-count":25,"publisher":"Wiley","issue":"6","license":[{"start":{"date-parts":[[2020,10,31]],"date-time":"2020-10-31T00:00:00Z","timestamp":1604102400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["obgyn.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Ultrasound in Obstet &amp;amp; Gyne"],"published-print":{"date-parts":[[2020,12]]},"abstract":"<jats:title>ABSTRACT<\/jats:title><jats:sec><jats:title>Objectives<\/jats:title><jats:p>Pouch of Douglas (POD) obliteration can be predicted with a high degree of certainty and reproducibility using the dynamic transvaginal ultrasound (TVS) sliding\u2010sign technique. So far, studies on POD obliteration prediction have focused on tertiary\u2010care populations with high prevalence of endometriosis; however, POD obliteration may exist in individuals with asymptomatic endometriosis or other conditions. Our primary aim was to determine the prevalence of a negative sliding sign, representing POD obliteration, in a cohort of patients undergoing TVS for any gynecological indication.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>This was a prospective observational study of consecutive women with an indication for gynecological TVS, conducted at a high\u2010volume ultrasound practice between July and August 2018. Clinical and surgical history, indication for TVS and TVS findings were documented. The prevalence of TVS\u2010confirmed POD obliteration, determined by interpretation of the sliding sign, was calculated for the entire cohort and for the subgroups of women with and without risk factors for endometriosis. High risk for endometriosis was defined as having (1) a TVS referral for endometriosis\u2010like pelvic pain or endometriosis specifically and\/or (2) clinical symptoms or signs suggestive of endometriosis. Low risk was defined as the absence of these characteristics.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>During the study period, 1043 consecutive women underwent TVS. After excluding those who underwent transabdominal ultrasound, had a history of hysterectomy or with missing data, 909 women were analyzed. The prevalence of a negative sliding sign in the entire cohort was 47\/909 (5.2%). A negative sliding sign was observed in 22\/639 (3.4%) women with a low risk for endometriosis and 25\/243 (10.3%) of those with a high risk for endometriosis (difference in proportions, 6.9% (95%\u2009CI 2.8\u201310.9%); <jats:italic>P<\/jats:italic>\u2009&lt;\u20090.001).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>We have demonstrated an overall prevalence of a negative sliding sign, suggesting POD obliteration, of 5.2% (or 1\/20) in women seeking TVS for a gynecological indication. The prevalence of negative sliding sign in low\u2010risk women is not negligible (3.4% or 1\/29 women). These women are most likely to have asymptomatic endometriosis or another important etiology of POD obliteration. The prevalence of a negative sliding sign is approximately three\u2010times higher in women with signs and\/or symptoms of endometriosis (10.3% <jats:italic>vs<\/jats:italic> 3.4%). Copyright \u00a9 2020 ISUOG. Published by John Wiley &amp; Sons Ltd.<\/jats:p><\/jats:sec>","DOI":"10.1002\/uog.22023","type":"journal-article","created":{"date-parts":[[2020,3,21]],"date-time":"2020-03-21T10:28:32Z","timestamp":1584786512000},"page":"928-933","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":27,"title":["Prevalence of negative sliding sign representing pouch of Douglas obliteration during pelvic transvaginal ultrasound for any indication"],"prefix":"10.1002","volume":"56","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5538-6906","authenticated-orcid":false,"given":"M.","family":"Leonardi","sequence":"first","affiliation":[{"name":"Acute Gynaecology, Early Pregnancy and Advanced Endosurgery Unit, Nepean Hospital, Sydney Medical School Nepean University of Sydney  Sydney Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7593-5607","authenticated-orcid":false,"given":"W. P.","family":"Martins","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, Ribeir\u00e3o Preto Medical School University of S\u00e3o Paulo  Ribeir\u00e3o Preto Brazil"},{"name":"SEMEAR Fertilidade, Reproductive Medicine  Ribeir\u00e3o Preto Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4330-6144","authenticated-orcid":false,"given":"M.","family":"Espada","sequence":"additional","affiliation":[{"name":"Acute Gynaecology, Early Pregnancy and Advanced Endosurgery Unit, Nepean Hospital, Sydney Medical School Nepean University of Sydney  Sydney Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"E.","family":"Georgousopoulou","sequence":"additional","affiliation":[{"name":"School of Medicine The University of Notre Dame Australia  Darlinghurst NSW Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3858-3080","authenticated-orcid":false,"given":"G.","family":"Condous","sequence":"additional","affiliation":[{"name":"Acute Gynaecology, Early Pregnancy and Advanced Endosurgery Unit, Nepean Hospital, Sydney Medical School Nepean University of Sydney  Sydney Australia"},{"name":"OMNI Ultrasound and Gynaecological Care  St Leonards NSW Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2020,10,31]]},"reference":[{"key":"e_1_2_7_2_1","doi-asserted-by":"publisher","DOI":"10.1001\/jama.1914.02560360015006"},{"key":"e_1_2_7_3_1","doi-asserted-by":"publisher","DOI":"10.1002\/uog.12305"},{"key":"e_1_2_7_4_1","doi-asserted-by":"publisher","DOI":"10.1002\/uog.12431"},{"key":"e_1_2_7_5_1","doi-asserted-by":"publisher","DOI":"10.1093\/humrep\/deu078"},{"key":"e_1_2_7_6_1","doi-asserted-by":"publisher","DOI":"10.1002\/uog.15661"},{"key":"e_1_2_7_7_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jmig.2018.09.777"},{"key":"e_1_2_7_8_1","doi-asserted-by":"publisher","DOI":"10.1002\/uog.15955"},{"key":"e_1_2_7_9_1","doi-asserted-by":"publisher","DOI":"10.1002\/uog.20176"},{"key":"e_1_2_7_10_1","doi-asserted-by":"publisher","DOI":"10.1097\/AOG.0000000000002480"},{"key":"e_1_2_7_11_1","doi-asserted-by":"publisher","DOI":"10.1002\/uog.17465"},{"key":"e_1_2_7_12_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jogc.2018.05.041"},{"key":"e_1_2_7_13_1","doi-asserted-by":"publisher","DOI":"10.1093\/humrep\/deg136"},{"key":"e_1_2_7_14_1","doi-asserted-by":"publisher","DOI":"10.1093\/humrep\/dew293"},{"key":"e_1_2_7_15_1","doi-asserted-by":"publisher","DOI":"10.1002\/ajum.12093"},{"key":"e_1_2_7_16_1","doi-asserted-by":"publisher","DOI":"10.7863\/ultra.33.6.1122"},{"key":"e_1_2_7_17_1","doi-asserted-by":"publisher","DOI":"10.1046\/j.1469-0705.2000.00287.x"},{"key":"e_1_2_7_18_1","doi-asserted-by":"publisher","DOI":"10.1002\/uog.14806"},{"key":"e_1_2_7_19_1","doi-asserted-by":"publisher","DOI":"10.1055\/s-0044-101254"},{"key":"e_1_2_7_20_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0889-8545(05)70302-8"},{"key":"e_1_2_7_21_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMcp1000274"},{"key":"e_1_2_7_22_1","first-page":"71","article-title":"Female genital tuberculosis: Revisited","volume":"148","author":"Sharma JB","year":"2018","journal-title":"Indian J Med Res"},{"key":"e_1_2_7_23_1","article-title":"Imaging modalities for the non\u2010invasive diagnosis of endometriosis","volume":"2","author":"Nisenblat V","year":"2016","journal-title":"Cochrane Database Syst Rev"},{"key":"e_1_2_7_24_1","doi-asserted-by":"publisher","DOI":"10.1002\/jum.15015"},{"key":"e_1_2_7_25_1","doi-asserted-by":"publisher","DOI":"10.1002\/uog.19057"},{"key":"e_1_2_7_26_1","doi-asserted-by":"publisher","DOI":"10.1111\/ajo.12242"}],"container-title":["Ultrasound in Obstetrics &amp; 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