Accuracy of Abdominal Striae Gravidarum, Scar Characteristics, and Pre-operative Sonographic Sliding Sign for Prediction of Intra-abdominal Adhesions in Pregnant Women with a History of Previous Cesarean Deliveries

Background & Objective: Intra-Abdominal Adhesions (IAA) are a common complication of prior Cesarean Delivery (CD) and may increase operative difficulty during repeat surgery. This study evaluated the diagnostic accuracy of abdominal striae gravidarum, scar characteristics, and the preoperative sonographic sliding sign for predicting IAA in women with a prior CD.Materials & Methods: This prospective cohort study included ۱۸۰ women with one prior CD who underwent repeat CD at Rajavithi Hospital between September ۲۰۲۴ and July ۲۰۲۵. Striae gravidarum were graded using Davey’s scoring system, scar characteristics were assessed using a standardized scale, and the sliding sign was evaluated by transabdominal sonography. Surgeons, blinded to these assessments, evaluated IAA intraoperatively using the Peritoneal Adhesion Index (PAI), with PAI ≥ ۶ indicating the presence of adhesions. Diagnostic accuracy was assessed using the area under the receiver operating characteristic Curve (AUC), sensitivity, specificity, Positive Predictive Value (PPV), and Negative Predictive Value (NPV) for each predictor and their combinations.Results: IAA were identified in ۷.۲% (۱۳.۱۸۰) of women undergoing repeat CD. Striae gravidarum showed the highest sensitivity (۸۴.۶%), while a negative sliding sign demonstrated the highest accuracy (AUC ۰.۸۰۷; NPV ۹۷.۵%). The Triple S Model showed superior discrimination (AUC ۰.۸۷۷; ۹۵% CI, ۰.۷۸۴-۰.۹۷۰). At a cutoff score of ۳, sensitivity and specificity were ۸۴.۶% and ۸۲.۶%, respectively, with a PPV of ۲۷.۵% and an NPV of ۹۸.۶%.Conclusion: The Triple S Model may be useful for ruling out intra-abdominal adhesions in women with prior cesarean delivery; however, its low PPV limits the identification of high-risk cases, and external validation is required before clinical implementation.

کلیدواژه ها:

Cesarean Delivery ، Intra-abdominal adhesions ، Striae gravidarum ، Scar ، Ultrasonography