الفهرس 
Aim of the studyOnly 14 pages are availabe for public view
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Abstract
Global rates of cesarean section are increasing dramatically nowadays. A major complication of repeated CS is adhesions formation which makes future CS more difficult and more complicated. Adhesions commonly form within the vesico-uterine space or between the anterior abdominal wall and uterus. And, with each successive pregnancy, the percentage of affected women and adhesion severity rise. The reported prevalence of adhesions is 12 to 46 percent of women at their second cesarean and 26 to 75 percent of women at their third cesarean Adhesions can significantly lengthen incision to delivery time and total operative time. Several strategies have been suggested for the preoperative prediction of intra-abdominal adhesions, including skin scar visual characteristics and surgical history. However, these methods suffer from lack of reproducibility. The current study was an observational one conducted in the obstetrics and gynecology department, Menoufia faculty of medicine hospitals and shebin elkom teaching hospital and aimed to evaluate the efficacy of abdominal ultrasound to predict intra-abdominal adhesion prior planned repeated cesarean section. In our study, 69 pregnant women with previous abdomino-pelvic surgery were recruited. Each patient was subjected to abdominal ultrasound to detect sliding sign between the uterine wall and anterior abdominal wall. A positive sliding sign is considered if the anterior uterine wall was seen sliding across the abdominal wall and a negative sliding sign is considered when there was no such relative motion. Intra-operatively, we recorded whether adhesions were present or not, how severe they were, and whether they were associated with significant blood loss or visceral injury or increase the duration of delivery and the operative findings were correlated with corresponding ultrasound sliding sign. The mean age of participants was 26.36 years, while the mean BMI was 27.29 kg/m2, 88.4% of the recruited patients had positive sliding sign, while 11.6% had negative sliding sign. 81.2% of patients had no adhesions on CS procedure, while 10.1% of them had marked adhesions. 4.3% of patients complicated with visceral injury. Only 2.9% of patients complicated with HB DROP > 3g/dl and 5.8% complicated with HB DROP between 2-3 g/dl. Positive sliding sign correctly identified 59(96.7%) out of 61 patients who had no or mild adhesions on CS procedure while negative sliding sign correctly identified 5(62.5%) out of 8 patients who had marked adhesions on CS procedure. Accordingly, the sensitivity, specificity, PPV and NPV of sliding sign in predicting marked intra-operative adhesions were 71.4%, 95.2%, 62.5% and 96.7% respectively. The median of delivery time (time from skin incision till delivery of baby) was significantly longer in patients with negative sliding sign compared to those with positive sliding sign (16.5 minutes versus 6 minutes). Also, patients with negative sliding sign are more liable to intra operative bleeding as 12.5% of them complicated with Hb DROP from2 to 3 g/dl and 25% more than 3 g/dl while 4.9% of patients with positive sliding sign complicated with Hb DROP from 2 to 3 g/dl and 0% more than 3 g/dl. Also visceral injuries were more common in patients with negative sliding sign as 25% of patients with negative sliding sign complicated with visceral injury while 1.6% of patients with positive sliding sign complicated with visceral injury. Based on our results, the current study demonstrated that a negative uterine sliding sign can predict severe intra-abdominal adhesions encountered during repeat cesarean delivery. Furthermore, a longer time to delivery and a higher chance of both intra-operative bleeding and visceral injury were more common in the patients with negative sliding sign.