الفهرس 
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Abstract
SUMMARY
a
dhesions are the most frequent complication following abdominal and pelvic surgery, developing after more than 90% of interventions concerning the abdominal cavity.
This represents a considerable healthcare issue, as it has a significant impact both on the patient, increasing morbidity and mortality, and on healthcare costs. It is therefore important for surgeons to detect patients at high risk of having adhesions. This information can permit preoperative planning by a multidisciplinary team of surgeons and allow the patient to be informed of the potentially high risk of complications.
Dynamic ultrasound techniques such as transabdominal and transvaginal sonographic sliding sign have also been used to predict adhesions before surgery.
In this study, we aimed to evaluate the efficiency of preoperative transvaginal ultrasonographic features in prediction of intra-abdominal adhesions in pregnant women during third-trimester with history of previous cesarean surgery scheduled for a planned repeat elective C.S. delivery.
This prospective study was conducted at tertiary care hospital at Souad Kafafi hospital at Misr University for Science and Technology and Kasr Al-Ainy new obstetrics and gynecology hospital - Cairo University from March 2021 until August 2021 and performed on total 200 patients who underwent elective caesarean delivery.
Examination of the sliding sign was performed successfully in all cases. Absence of sliding of the uterus was noted in 23 patients, whereas sliding was present in 177 women. The suspicion of presence of intra-abdominal adhesions was confirmed at surgery as moderate and severe adhesions in 20 of the 23 cases assigned to be the high-risk cases.
Negative sliding sign was found in 64.7% of cases with severe intra-abdominal adhesions with statistically significantly correlated with highest operative time and blood loss during surgery with documented four cases of bladder injuries and one case of intestinal injury in cases with severe adhesions which were more frequent in cases with negative sliding sign.
The findings of our study demonstrated a good capability of a simple third-trimester transvaginal sonographic sign, the absence of sliding of the uterus, to predict the presence of intra-abdominal adhesions in women undergoing repeat CS.
We concluded that the real-time dynamic transvaginal ultrasound sliding sign is a non-invasive, well-tolerated technique. Its preoperative analysis in patients who have had previous abdominopelvic surgery may help to evaluate the risk of bowel or bladder injury and the complexity of the planned intervention, improving the safety of surgery, and may help to inform the anesthesiologist regarding the expected duration of the intervention and any potential complications during the procedure.
We recommend applying a preoperative transvaginal ultrasonogram for the detection of severe intra-abdominal adhesions to predict severe adhesions, based on a negative sliding sign, can possibly result in better planning and safer conduct of surgery.