Prediction of Intraperitoneal Adhesions in Repeated Cesarean Section Using Sliding Sign, Striae Gravidarum, and Cesarean Scar

Abstract

Background: Intraabdominal adhesions are associated with an increase in complications during cesarean section because of recurrent cesarean sections. This is why the possibility of predicting adhesions is important. In this study, the diagnostic value of depressed scar, severe striae gravidarum, and negative sliding sign, and their combinations were evaluated for predicting intraabdominal adhesions of cesarean candidates. Methods: This prospective descriptive study was performed during 2019-2020 on 123 pregnant women referred to Ayatollah Taleghani university hospital with a gestational age of ≥36 weeks 0 days who were candidates for cesarean section because of a previous cesarean section. In each patient, the presence of a depressed scar, a severe striae gravidarum, the absence of a sliding sign, and the presence and severity of adhesions during the operation were examined. Sensitivity and specificity, and positive and negative predictive values of each of the 3 indicators and their combinations were calculated. Results: The frequency distribution of severe adhesion in these individuals was 16.27%. The highest sensitivity was related to depressed scar and negative sliding sign (65%). The highest specificity was related to the negative sliding sign and its combinations (97%-99%). The highest positive predictive value was related to negative sign sliding and its combinations (81%-92%). The negative predictive values of depressed scar, negative sliding sign, and severe striae gravidarum, and even their combinations were almost the same and approximately between 89% and 93%. Conclusion: To predict the presence of adhesions in a cesarean candidate because of a previous cesarean section, you should first examine the striae gravidarum and scar. In the absence of a depressed scar and severe striae gravidarum, there is a 90% chance of no adhesions. According to this study, if both signs are present, it is recommended to check the sliding sign to obtain a more accurate estimate.

Keywords: Cesarean Scar; Cesarean Section; Intraperitoneal Adhesions; Prediction; Sliding Sign; Striae Gravidarum.