الفهرس 
Sliding sign for intra-abdominal adhesion prediction before repeat cesarean delivery
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Abstract
Objective: To evaluate the efficiency of the ultra sonographic uterine sliding sign to predict intra-abdominal adhesions in patients scheduled for a planned repeat cesarean delivery. Methods: 300 pregnant women were included. During trans abdominal ultra sonography, while the parturient breathed deeply, the sonographer recorded a video clip in a sagittal plane lateral to the umbilicus. These clips were assessed for the presence (sliding-positive) or absence (sliding-negative) of relative movement between the maternal abdominal and uterine wall. Surgeons blinded to ultra sonography results graded the severity of intra peritoneal adhesions intra operatively. The operative findings were correlated to the corresponding ultra sonographic sliding sign. Results: A negative sliding sign was associated with severe adhesions (sensitivity 54.5%, specificity 98.2%, PPV 70.6% and NPV 96.5%). Statistically significant longer delivery time in patients with negative sign compared to positive ones (18 minute versus 8 minutes). Conclusion: A negative sliding sign predicts severe intra-abdominal adhesions encountered during repeat cesarean delivery, longer time to delivery, and a higher chance of bleeding and visceral injury