Abstract

ABSTRACT

Aim: This study evaluated the diagnostic accuracy and reliability of the sonographic sliding sign (SSS) in predicting intra-abdominal adhesions and its association with immediate postoperative outcomes in third-trimester women undergoing repeat cesarean section at Kilimanjaro Christian Medical Center (KCMC).

Methods: In a prospective cohort of 265 women, the presence or absence of the sliding sign was assessed using transabdominal ultrasound and compared with surgical findings as the gold standard from May 2024 to May 2025 with the data collection period starting from November 2024 and ending in April 2025 followed up by data analysis.

Results: The sonographic sliding sign demonstrated a strong diagnostic performance for detecting adhesions, with sensitivity 81.8%, specificity 88.3%, PPV 88.2%, NPV 81.9%, and an AUC of 0.85. When assessed for its ability to predict adhesion severity, the tool showed a sensitivity and specificity of 81.9% and 89.8% for no/mild adhesions, 61.5% and 92.0% for moderate adhesions, and 73.3% and 92.0% for severe adhesions, respectively. Inter- and intra-observer reliability were substantial, with Cohen’s Kappa values of 0.64 and 0.76. A negative sliding sign was significantly associated with longer skin-to-delivery times (mean difference: 4.03 minutes, p = 0.001) and longer total operating times (mean difference: 14.2 minutes, p < 0.001).

Conclusion: These findings underscore the sliding sign as a reliable, non-invasive, and clinically useful tool for preoperative planning in repeat cesarean deliveries, particularly in resource-limited, high-parity settings. Routine use may aid in optimizing surgical preparedness and improving maternal outcomes.

Key words: Adhesions, Cesarean delivery, KCMC, Sonographic sliding sign, Ultrasound.