الفهرس 
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Abstract
The present study is a prospective cohort study validates the use of dynamic ultrasound for prediction of intra-abdominal adhesions in women undergoing repeated cesarean section. The study included 120 pregnant women in third trimester planned to undergo elective cesarean section.
The mean maternal age was 26.70±5.01 years and ranged from 20 to 40 years, median parity was 2 and ranged from 1 to 5, and median abortion was 0 and ranged from 0 to 3 previous abortions. 43 (36%) of the women
had undergone only one previous CS, 36 (30%) had two and 41 (34%) more than two previous CS deliveries.
57 (47%) delivered at public place and 63 (53%) delivered at private place. At the time of delivery most neonate were full term (≥ 37 week) 100 (83%) versus 20 (17%) were preterm (33 - 36 weeks). Median BMI of studied women at the time of delivery (kg/m2) was 29.4 and ranged from
19.8 to 44.4 kg/m2, more than half were overweight and obese 49 (41%) and 53 (44%) respectively.
There were statistically significant associations between the presences or absences of intra-operative adhesions and maternal age groups (years), where women with age ≥ 30 years old have higher incidence of adhesions than women with younger age (p=0.004); number of previous parity, where women with higher parity ≥ 3 have higher incidence of adhesions than women with lower parity (p=0.000); number of previous CS, with increased the number of previous CS there is increase in the incidence of adhesions (p=0.000); gestational age (weeks), where pre-term (33-36 w) delivers associated with higher incidence of adhesions (p=0.002); and BMI (kg/m2), where obese women have higher incidence of adhesions (p= 0.000). Meanwhile there were no statistically significant
associations between intra-operative adhesions and the number of previous abortions, and the place of delivery (p=0.969 and 0.516) respectively.
Negative sliding of the uterus was noted in 54 patients, whereas positive sliding was present in 66 women. The suspicion of presence of intra-abdominal adhesions was confirmed at surgery in 53 of the 54 cases assigned to the high-risk group, whilst the prediction of low risk for adhesions was confirmed in 49 of 66 patients, and by measuring the predictive ability of sliding sign for the detection of intra-abdominal adhesions in women with repeat cesarean delivery using the ROC curve analysis we founded that the area under the ROC curves was 86.9% (95% CI 0.802-0.935), sensitivity of 75.7% (95% CI, 64.5-84.25), specificity of
98.0% (95% CI, 89.5-99.65), PPV of 98.2% (95% CI, 90.23-99.67), NPV
of 74.2% (95% CI, 62.57, 83.25), LR+ of 37.86 and LR−of 0.25 with
overall accuracy 85% (95% CI, 0.802-0.935), p=0.000. our results confirmed by logistic regression analysis which show that, women with negative sliding sign were about 153 times more likely of having intra- abdominal adhesions as compared to women with positive sliding sign (OR=152.77, 95%CI 19.59 – 1191.24, p=0.000).
The present results and other existing data show that the use of dynamic ultrasound for prediction of intra-abdominal adhesions in women undergoing repeated cesarean section is safe effective method. Larger, prospective, randomized trials are needed to confirm the data for better delivery outcomes and for better quality of life. There is a vital need for the development of individualized interventions programs tailored to the physical and psychological well-being of pregnant women in Assuit University.