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Preoperative sonographic prediction of intra-abdominal adhesions using sliding sign at repeat caesarean section at the University of Maiduguri Teaching Hospital, Nigeria: a prospective observational study

OBJECTIVE: To determine if the presence or absence of sonographic sliding sign preoperatively is a good predictor of the presence and type of intra-abdominal adhesions; and to determine the time taken to demonstrate this sign. DESIGN: A prospective, observational, triple-blind study using tests of d...

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Autores principales: Bukar, Mohammed, Mana, Asta Umar, Ikunaiye, Nasiru
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BMJ Publishing Group 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8739072/
https://www.ncbi.nlm.nih.gov/pubmed/34992098
http://dx.doi.org/10.1136/bmjopen-2020-046334
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author Bukar, Mohammed
Mana, Asta Umar
Ikunaiye, Nasiru
author_facet Bukar, Mohammed
Mana, Asta Umar
Ikunaiye, Nasiru
author_sort Bukar, Mohammed
collection PubMed
description OBJECTIVE: To determine if the presence or absence of sonographic sliding sign preoperatively is a good predictor of the presence and type of intra-abdominal adhesions; and to determine the time taken to demonstrate this sign. DESIGN: A prospective, observational, triple-blind study using tests of diagnostic accuracy. SETTING: Single-centre tertiary health institution in north-east Nigeria. PARTICIPANTS: 67 women in the third trimester scheduled for repeat elective caesarean sections (CS) had transabdominal sonography to determine the absence or presence and degree of sliding sign. The time taken to make these decisions were noted. Surgeons blinded to the ultrasound findings graded adhesions intraoperatively and comparison between sonographic and intraoperative findings made. Women who were scheduled for emergency CS were excluded. MAIN OUTCOME MEASURES: Accuracy of preoperative ultrasound to determine no/mild, moderate and severe adhesions. Secondary outcomes were interobserver correlations and time taken to determine sliding. RESULTS: When classified as adhesion and no adhesion, the sliding sign demonstrated a sensitivity of 100.00% (CI(95) 85.18% to 100.00%), specificity of 100.00% (CI(95) 92.13% to 100.00%). In predicting presence of moderate intra-abdominal adhesions, a sensitivity of 65.0% (CI(95) 40.78% to 84.61%) and specificity of 82.98% (CI(95) 69.19% to 92.35%) was found. For predicting severe intra-abdominal adhesions, it had a sensitivity of 25.00% (CI(95) 0.63% to 80.59%) and specificity of 98.41 (CI(95) 91.47 to 99.96). Disease prevalence for mild, moderate and severe adhesions was 33.82% (CI(95) 22.79% to 46.32%), 29.85% (CI(95) 19.28% to 42.27%) and 5.97% (CI(95) 1.65% to 14.59%), respectively. Interobserver Cohen’s kappa coefficient and PPA were 0.58 (CI(95) 0.39 to 0.76) and 58.82 (CI(95) 52.82 to 64.82), respectively. The mean duration to determine sliding sign was 7.56±2.86 s. CONCLUSION: This study supports the role of transabdominal sliding sign in preoperative prediction of intra-abdominal adhesions in women with previous CS without significant increase in sonography duration. This information can encourage planning for CS by ensuring that surgeons of appropriate seniority are deployed to undertake anticipated complex operations.
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spelling pubmed-87390722022-01-20 Preoperative sonographic prediction of intra-abdominal adhesions using sliding sign at repeat caesarean section at the University of Maiduguri Teaching Hospital, Nigeria: a prospective observational study Bukar, Mohammed Mana, Asta Umar Ikunaiye, Nasiru BMJ Open Obstetrics and Gynaecology OBJECTIVE: To determine if the presence or absence of sonographic sliding sign preoperatively is a good predictor of the presence and type of intra-abdominal adhesions; and to determine the time taken to demonstrate this sign. DESIGN: A prospective, observational, triple-blind study using tests of diagnostic accuracy. SETTING: Single-centre tertiary health institution in north-east Nigeria. PARTICIPANTS: 67 women in the third trimester scheduled for repeat elective caesarean sections (CS) had transabdominal sonography to determine the absence or presence and degree of sliding sign. The time taken to make these decisions were noted. Surgeons blinded to the ultrasound findings graded adhesions intraoperatively and comparison between sonographic and intraoperative findings made. Women who were scheduled for emergency CS were excluded. MAIN OUTCOME MEASURES: Accuracy of preoperative ultrasound to determine no/mild, moderate and severe adhesions. Secondary outcomes were interobserver correlations and time taken to determine sliding. RESULTS: When classified as adhesion and no adhesion, the sliding sign demonstrated a sensitivity of 100.00% (CI(95) 85.18% to 100.00%), specificity of 100.00% (CI(95) 92.13% to 100.00%). In predicting presence of moderate intra-abdominal adhesions, a sensitivity of 65.0% (CI(95) 40.78% to 84.61%) and specificity of 82.98% (CI(95) 69.19% to 92.35%) was found. For predicting severe intra-abdominal adhesions, it had a sensitivity of 25.00% (CI(95) 0.63% to 80.59%) and specificity of 98.41 (CI(95) 91.47 to 99.96). Disease prevalence for mild, moderate and severe adhesions was 33.82% (CI(95) 22.79% to 46.32%), 29.85% (CI(95) 19.28% to 42.27%) and 5.97% (CI(95) 1.65% to 14.59%), respectively. Interobserver Cohen’s kappa coefficient and PPA were 0.58 (CI(95) 0.39 to 0.76) and 58.82 (CI(95) 52.82 to 64.82), respectively. The mean duration to determine sliding sign was 7.56±2.86 s. CONCLUSION: This study supports the role of transabdominal sliding sign in preoperative prediction of intra-abdominal adhesions in women with previous CS without significant increase in sonography duration. This information can encourage planning for CS by ensuring that surgeons of appropriate seniority are deployed to undertake anticipated complex operations. BMJ Publishing Group 2022-01-06 /pmc/articles/PMC8739072/ /pubmed/34992098 http://dx.doi.org/10.1136/bmjopen-2020-046334 Text en © Author(s) (or their employer(s)) 2022. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ. https://creativecommons.org/licenses/by-nc/4.0/This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/ (https://creativecommons.org/licenses/by-nc/4.0/) .
spellingShingle Obstetrics and Gynaecology
Bukar, Mohammed
Mana, Asta Umar
Ikunaiye, Nasiru
Preoperative sonographic prediction of intra-abdominal adhesions using sliding sign at repeat caesarean section at the University of Maiduguri Teaching Hospital, Nigeria: a prospective observational study
title Preoperative sonographic prediction of intra-abdominal adhesions using sliding sign at repeat caesarean section at the University of Maiduguri Teaching Hospital, Nigeria: a prospective observational study
title_full Preoperative sonographic prediction of intra-abdominal adhesions using sliding sign at repeat caesarean section at the University of Maiduguri Teaching Hospital, Nigeria: a prospective observational study
title_fullStr Preoperative sonographic prediction of intra-abdominal adhesions using sliding sign at repeat caesarean section at the University of Maiduguri Teaching Hospital, Nigeria: a prospective observational study
title_full_unstemmed Preoperative sonographic prediction of intra-abdominal adhesions using sliding sign at repeat caesarean section at the University of Maiduguri Teaching Hospital, Nigeria: a prospective observational study
title_short Preoperative sonographic prediction of intra-abdominal adhesions using sliding sign at repeat caesarean section at the University of Maiduguri Teaching Hospital, Nigeria: a prospective observational study
title_sort preoperative sonographic prediction of intra-abdominal adhesions using sliding sign at repeat caesarean section at the university of maiduguri teaching hospital, nigeria: a prospective observational study
topic Obstetrics and Gynaecology
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8739072/
https://www.ncbi.nlm.nih.gov/pubmed/34992098
http://dx.doi.org/10.1136/bmjopen-2020-046334
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