{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,2]],"date-time":"2026-04-02T08:47:44Z","timestamp":1775119664104,"version":"3.50.1"},"reference-count":49,"publisher":"Wiley","issue":"6","license":[{"start":{"date-parts":[[2024,11,12]],"date-time":"2024-11-12T00:00:00Z","timestamp":1731369600000},"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; Gyne"],"published-print":{"date-parts":[[2024,12]]},"abstract":"<jats:title>ABSTRACT<\/jats:title><jats:sec><jats:title>Objectives<\/jats:title><jats:p>To assess the accuracy and utility of transabdominal sonographic paraumbilical and suprapubic sliding signs in predicting intra\u2010abdominal adhesions in women undergoing repeat Cesarean section (CS), and to investigate the association of repeat CS with short\u2010term maternal and neonatal outcomes.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>This was a prospective observational study of pregnant women with a history of CS who were scheduled for third\u2010trimester elective or emergency CS at a tertiary referral and teaching hospital between July 2021 and June 2022. In order to evaluate the role of transabdominal sonographic paraumbilical and suprapubic sliding signs in the prediction of intra\u2010abdominal adhesions, participants underwent a high\u2010resolution transabdominal ultrasound scan prior to  repeat CS. Free cephalad and caudad gliding of the uterus under the abdominal wall during deep inhalation and exhalation in each area was considered a positive sliding sign, suggesting a low risk of intra\u2010abdominal adhesions. The absence of such movement was considered a negative sliding sign, suggesting a high risk of intra\u2010abdominal adhesions. The presence or absence of intra\u2010abdominal adhesions was then confirmed during surgery by physicians who were blinded to the sonographic sliding\u2010sign findings. The type of adhesion, structures involved, method of adhesiolysis, incision\u2010to\u2010delivery time, 1\u2010min and 5\u2010min Apgar scores, maternal and neonatal injury and other short\u2010term complications were also reported.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Of  419  women with a history of at least one previous CS who underwent  repeat CS, the preoperative sonographic paraumbilical and suprapubic sliding signs were negative in 173 (41.3%) and 178 (42.5%) women, respectively. On repeat CS, 224 (53.5%) women had intra\u2010abdominal adhesions, of which  165 (39.4%) had dense adhesions and 59 (14.1%) had only filmy adhesions. The sensitivity and specificity of a negative preoperative paraumbilical sliding sign in predicting the presence of dense intra\u2010abdominal adhesions in women undergoing repeat CS were 94.6% (95%\u2009CI, 92.4\u201396.7%) and 93.3% (95%\u2009CI, 90.9\u201395.7%), respectively. A negative suprapubic sliding sign also showed high sensitivity (95.2% (95%\u2009CI, 93.1\u201397.2%)) and specificity  (91.7% (95%\u2009CI, 89.1\u201394.4%)). Additionally, a negative sliding sign at both locations in the same patient had robust sensitivity (90.2% (95%\u2009CI, 87.3\u201393.0%)) and specificity (96.3% (95%\u2009CI, 94.5\u201398.1%)). We found that the risk of dense intra\u2010abdominal adhesions increased with parity and the number of previous CS. Dense intra\u2010abdominal adhesions were associated with increased incision\u2010to\u2010delivery time, higher risk of maternal bladder injury, intraoperative bleeding and postpartum hemorrhage.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Dense intra\u2010abdominal adhesions are common in women with a history of CS and are associated with delayed delivery of the neonate and increased risk of adverse maternal outcomes. The transabdominal sonographic paraumbilical and suprapubic sliding signs are robust methods for the accurate preoperative prediction of dense intra\u2010abdominal adhesions in patients with a history of CS. As the techniques are easy to learn and perform, the sliding sign should be used more widely for triaging patients at high risk of dense intra\u2010abdominal adhesions for appropriate preoperative planning. \u00a9 2024 International Society of Ultrasound in Obstetrics and Gynecology.<\/jats:p><\/jats:sec>","DOI":"10.1002\/uog.29133","type":"journal-article","created":{"date-parts":[[2024,11,13]],"date-time":"2024-11-13T11:43:51Z","timestamp":1731498231000},"page":"792-798","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":5,"title":["Transabdominal sonographic sliding signs for preoperative prediction of dense intra\u2010abdominal adhesions in women undergoing repeat Cesarean delivery"],"prefix":"10.1002","volume":"64","author":[{"ORCID":"https:\/\/orcid.org\/0009-0007-5516-0430","authenticated-orcid":false,"given":"M.","family":"Mayibenye","sequence":"first","affiliation":[{"name":"Department of Obstetrics and Gynaecology, Faculty of Medicine and Health Sciences Walter Sisulu University  Mthatha South Africa"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"G. A. B.","family":"Buga","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynaecology, Faculty of Medicine and Health Sciences Walter Sisulu University  Mthatha South Africa"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"M. L.","family":"Mdaka","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynaecology, Faculty of Medicine and Health Sciences Walter Sisulu University  Mthatha South Africa"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"M. K.","family":"Nanjoh","sequence":"additional","affiliation":[{"name":"Department of Public Health, Faculty of Medicine and Health Sciences Walter Sisulu University  Mthatha South Africa"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2024,11,12]]},"reference":[{"key":"e_1_2_8_2_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmjgh-2021-005671"},{"key":"e_1_2_8_3_1","doi-asserted-by":"crossref","unstructured":"OstermannMJK.Changes in primary and repeat cesarean delivery: United States 2016\u20102021. 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