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

This review aimed to assess diagnostic accuracy of transabdominal ultrasonography (TAS) sliding sign in diagnosing severe intra-abdominal adhesions with repeated Caesarean delivery (CD). PubMed, Google Scholar, Web of Science and Scopus were searched for published studies until October 2022. Studies evaluating the sliding sign as a predictor of intra-abdominal adhesions after repeat CD were included. STATA and Comprehensive Meta-Analysis for meta-analysis was used. A total of 7 studies (1,318 patients) were included. For identifying severe intra-abdominal adhesions, sliding sign on TAS had a combined sensitivity (64%, 95% confidence interval [CI]: 55-71%), specificity (93%, 95% CI: 89-96%), positive likelihood ratio (9.5, 95% CI: 5.7-16), negative likelihood ratio (0.39, 95% CI: 0.31-0.49) and diagnostic odds ratio (24, 95% CI: 13-46). Prediction intervals for sensitivity and specificity were 0.444-0.786 and 0.711-0.985, respectively. 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.