Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2025 May 7;17(5):e83645.
doi: 10.7759/cureus.83645. eCollection 2025 May.

Predicting the Presence of Intra-abdominal Adhesions in Pregnant Women Undergoing a Repeat Cesarean Section by Assessing the Ultrasound Sliding Sign: A Prospective Observational Study

Nallaballe Shalini  1 , Shailaja Bidri  1 , Ravi Kumar Yeli  2 , Rajasri G Yaliwal  1 , Aruna Biradar  1 , Preeti S Malapure  1
Affiliations

Predicting the Presence of Intra-abdominal Adhesions in Pregnant Women Undergoing a Repeat Cesarean Section by Assessing the Ultrasound Sliding Sign: A Prospective Observational Study

Nallaballe Shalini et al. Cureus. .

Abstract

Background Cesarean section (CS) is a common obstetric procedure, with repeat CS increasing the risk of intra-abdominal adhesions, leading to surgical complications. The ultrasound sliding sign has been proposed as a non-invasive tool to predict adhesions, but its diagnostic accuracy remains under evaluation. This study aims to assess the accuracy of the ultrasound sliding sign in predicting intra-abdominal adhesions in repeat CS cases and evaluate its correlation with intraoperative findings. Methodology A prospective observational study was conducted at BLDE (D.U.) Shri B.M. Patil Medical College from May 2023 to December 2024, including 200 women undergoing repeat CS. Preoperative ultrasound evaluated the sliding sign, classifying cases as positive (free uterine movement, no adhesions) or negative (restricted movement, adhesions). Intraoperative findings were recorded for correlation. Statistical analysis was performed using SPSS version 26 (IBM Corp., Armonk, NY, USA). Results Among the participants, 40% had adhesions. The ultrasound sliding sign demonstrated 86.1% sensitivity, 85.8% specificity, 77.5% positive predictive value, and 91.6% negative predictive value. Adhesions were significantly associated with maternal age (>30 years), parity (≥2), higher body mass index, and multiple previous CSs. Conclusions The ultrasound sliding sign is a reliable, non-invasive tool for predicting intra-abdominal adhesions in repeat CS, aiding in surgical preparedness. Given its high diagnostic accuracy, it can enhance clinical decision-making; however, further studies are needed to refine its application.

Keywords: cesarean section; intra-abdominal adhesions; maternal outcomes; non-invasive diagnostics; repeat cs; ultrasound sliding sign.

PubMed Disclaimer

Conflict of interest statement

Human subjects: Consent for treatment and open access publication was obtained or waived by all participants in this study. Institutional Ethics Committee, BLDE, Vijayapura issued approval IEC/895/2022-23. Animal subjects: All authors have confirmed that this study did not involve animal subjects or tissue. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work.

Figures

Figure 1
Figure 1. Study flowchart showing patient selection.
LSCS: lower-segment cesarean section
Figure 2
Figure 2. Distribution of maternal age with intra-abdominal adhesions.
Figure 3
Figure 3. Distribution of previous cesarean sections with intra-abdominal adhesions.
Figure 4
Figure 4. Distribution of body mass index (BMI) with intra-abdominal adhesions.
Figure 5
Figure 5. Receiver operating characteristic (ROC) curve analysis for the sliding sign.
See this image and copyright information in PMC

References

    1. Indications and determinants of cesarean section: a cross-sectional study. Singh N, Pradeep Y, Jauhari S. Int J Appl Basic Med Res. 2020;10:280–285. - PMC - PubMed
    1. Postoperative adhesion development following cesarean and open intra-abdominal gynecological operations: a review. Awonuga AO, Fletcher NM, Saed GM, Diamond MP. Reprod Sci. 2011;18:1166–1185. - PMC - PubMed
    1. An overview of postoperative intraabdominal adhesions and their role on female infertility: a narrative review. Ghobrial S, Ott J, Parry JP. J Clin Med. 2023;12:2263. - PMC - PubMed
    1. Adhesion barriers in gynecologic surgeries and cesarean section: an Asia-Pacific expert panel consensus recommendation. Tanigaki S, Batra A, Chan TF, et al. Int J Gynaecol Obstet. 2025;168:436–448. - PMC - PubMed
    1. Intra-abdominal adhesions among patients undergoing repeat caesarean section in Department of Obstetrics and Gynaecology of a tertiary care centre: a descriptive cross-sectional study. Pokhrel M, Sherpa LD, Thapa M, Sharma J. JNMA J Nepal Med Assoc. 2022;60:517–520. - PMC - PubMed

LinkOut - more resources