The effectiveness of preoperative diagnostic methods in predicting intra-abdominal adhesions before repeat cesarean section delivery.

Autor:	Sönmez S; University of Health Sciences, Bursa Yüksek İhtisas Training and Research Hospital, Department of Obstetrics and Gynecology - Bursa, Turkey., Akselim B; University of Health Sciences, Bursa Yüksek İhtisas Training and Research Hospital, Department of Obstetrics and Gynecology - Bursa, Turkey., Karaşin SS; University of Health Sciences, Bursa Yüksek İhtisas Training and Research Hospital, Department of Obstetrics and Gynecology - Bursa, Turkey.
Jazyk:	angličtina
Zdroj:	Revista da Associacao Medica Brasileira (1992) [Rev Assoc Med Bras (1992)] 2023 Apr 17; Vol. 69 (4), pp. e20221455. Date of Electronic Publication: 2023 Apr 17 (Print Publication: 2023).
DOI:	10.1590/1806-9282.20221455
Abstrakt:	Objective: This study aimed to evaluate the effectiveness of skin appearance, striae gravidarum severity, and ultrasonographic "sliding sign" in predicting preoperative adhesions before repeat cesarean section delivery on the same patient and find the most useful one. Methods: This was a prospective cohort study conducted on pregnant women with a history of cesarean section delivery. Davey's scoring system was used for stria evaluation. The scar was assessed using their visual appearance, and transabdominal ultrasonography was applied to detect sliding sign existence. Surgeons blinded to preoperative assessment graded the severity of intra-abdominal adhesions intraoperatively using Nair's scoring system. Results: Of the 164 pregnant women with at least one previous cesarean section delivery, 73 (44.5%) had filmy or dense intra-abdominal adhesions. Statistically significant association was found between three groups regarding parity, previous cesarean number, scar appearance, total stria score, and sliding sign existence. Negative sliding sign had a likelihood ratio of 4.198 (95%CI 1.178-14.964) for the detection of intra-abdominal adhesions. Stria score and scar appearance were also valuable for detection adhesions with likelihood ratios of 1.518 (95%CI 1.045-2.205) and 2.405 (95%CI 0.851-6.796), respectively. After receiver operator characteristics curve analysis, striae score cutoff value in adhesion prediction was determined as 3.5. Conclusion: Stria score, scar appearance, and sliding sign are all significant predictors for intraperitoneal adhesions, and sliding sign, as an easy-to-apply, inexpensive, useful sonographic marker, is the most effective adhesion predictor before repeat cesarean section delivery compared to other known adhesion markers.
Databáze:	MEDLINE
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