Predicting Intra-abdominal Adhesions for Repeat Cesarean Delivery with the Ultrasound Sliding Sign
Journal of Obstetrics and Gynaecology Canada, ISSN: 1701-2163, Vol: 43, Issue: 11, Page: 1274-1278
2021
- 6Citations
- 22Captures
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Metrics Details
- Citations6
- Citation Indexes6
- CrossRef6
- Captures22
- Readers22
- 22
Article Description
To evaluate the diagnostic value of the “sliding sign”, a sonographic test, in predicting intra-abdominal adhesions for women undergoing repeat cesarean delivery. This was a prospective observational study of women undergoing a scheduled repeat cesarean delivery at a regional hospital. The sliding sign is a sonographic observation of sliding movement between the uterus and the abdominal wall during deep breathing. The absence of the sliding sign was considered indicative of a high risk for dense uterine–abdominal adhesions, and this finding was compared with the operative findings. The primary outcome was the accuracy of the sliding sign in predicting adhesions. Secondary outcomes included incision-to-delivery time, operative time, and blood loss. We examined 112 pregnant women. Dense uterine–abdominal adhesions were found in 15 women, 8 of whom had no sliding sign identified on ultrasound. Therefore, the presence of the sliding sign detected 78 out of 97 women without uterine–abdominal adhesions. The sensitivity, specificity, and positive and negative predictive values of the sliding sign were 53.3%, 80.4%, 29.6%, and 91.8%, respectively. The intra- and inter-observer reliability using the kappa coefficient showed moderate consistency at 0.43 and 0.45, respectively. The sliding sign was less predictive than desired for clinical use, and it only detected half of the women with dense uterine–abdominal adhesions. Furthermore, a moderately low kappa coefficient indicates a lack of reproducibility, further emphasizing the sign's limited clinical value. Évaluer la valeur diagnostique du « signe de glissement », un test échographique, pour prédire la présence d'adhérences intra-abdominales chez les femmes devant subir une césarienne itérative. Il s'agit d'une étude observationnelle prospective menée auprès de femmes devant subir une césarienne itérative dans un centre hospitalier régional. Le signe de glissement est une observation échographique du mouvement de glissement entre l'utérus et la paroi abdominale pendant la respiration profonde. L'absence du signe de glissement a été considérée comme un indice de risque élevé d'adhérences utéro-abdominales importantes, et cette observation a été comparée aux observations intraopératoires. Le critère de jugement principal était l'exactitude du signe de glissement à prédire la présence d'adhérences. Les critères de jugement secondaires étaient le délai incision-extraction, le temps opératoire et le volume de perte sanguine. Nous avons examiné 112 femmes enceintes. Des adhérences utéro-abdominales importantes ont été observées chez 15 femmes, dont 8 chez qui aucun signe de glissement n'avait été observé à l’échographie. Par conséquent, la présence du signe de glissement a permis de détecter l'absence d'adhérence utéro-abdominale chez 78 femmes sur 97. La sensibilité, la spécificité et les valeurs prédictives positive et négative du signe de glissement étaient respectivement de 53,3 %, 80,4 %, 29,6 % et 91,8 %. La fiabilité intra- et interobservateur utilisant le coefficient kappa a montré une constance modérée de 0,43 et 0,45, respectivement. Le signe de glissement était moins prédictif que souhaité pour l'utilisation clinique, et les adhérences utéro-abdominales importantes ont été détectées seulement chez la moitié des femmes atteintes. De plus, un coefficient kappa modérément faible indique un manque de reproductibilité, ce qui insiste sur la valeur clinique limitée de ce signe.
Bibliographic Details
http://www.sciencedirect.com/science/article/pii/S1701216321004229; http://dx.doi.org/10.1016/j.jogc.2021.05.011; http://www.scopus.com/inward/record.url?partnerID=HzOxMe3b&scp=85110453111&origin=inward; http://www.ncbi.nlm.nih.gov/pubmed/34058401; https://linkinghub.elsevier.com/retrieve/pii/S1701216321004229; https://dx.doi.org/10.1016/j.jogc.2021.05.011
Elsevier BV
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