Diagnostic Accuracy of Abdominal Ultrasonographic Sliding Sign in the Evaluation of Severe Intra-Abdominal Adhesions involving the Uterus in Women Undergoing Repeat Cesarean Delivery: Systematic review and meta-analysis

Abstract

We aimed to assess diagnostic accuracy of transabdominal ultrasonography(TAS) sliding sign in diagnosing severe intra-abdominal adhesions with repeated Cesarian Delivery(CD). We comprehensively searched PubMed, Google Scholar, Web of Science, and Scopus for published studies till October 2022 that evaluated the sliding sign as a predictor of intra-abdominal adhesions after repeat CD. We used STATA and Comprehensive Meta-Analysis for meta-analysis. Seven studies(1318 patients) were eligible for inclusion. For identifying severe intra-abdominal adhesions, sliding sign on TAS had a combined sensitivity, specificity, positive likelihood ratio, negative likelihood ratio, and diagnostic odds ratio of 64%(95% CI, 55-71%), 93%(95% CI, 89-96%), 9.5(95% CI, 5.7-16), 0.39(95% CI, 0.31-0.49), and 24(95% CI, 13-46), respectively. Prediction intervals for sensitivity and specificity were 0.444 to 0.786 and 0.711 to 0.985, respectively. We concluded that sliding sign on TAS is a simple, non-invasive, good negative and practical method to exclude severe intra-abdominal adhesions involving the uterus with low sensitivity and high specificity.