Vesico-uterin Thickness and Sliding Sign in Term Pregnancies

The study aimed to evaluate the bladder and uterus ultrasonographically and intraabdominal adhesions prior the cesarean section. Pregnant women aged 18-45 years with singleton, viable third-trimester (37 weeks of gestation or later) pregnancies with the history of at least one previous cesarean section were included in the study. The control group consisted of healthy pregnant women in the third trimester with similar demographic characteristics who underwent elective (planned) cesarean delivery and had no obstetric or medical comorbidities. Control group had no history of previous cesarean section. The indications in control group for cesarean section consisted cephalopelvic disproportion and rare other malpresentations.Exclusion criteria included uterine anomalies, intra-abdominal cysts or myomas, multiple pregnancies, a history of additional intra-abdominal surgery, a history of steroid use, collagen disorders, and placental adhesion or invasion anomalies. To ensure homogeneity between groups, patients with comparable body mass index values were preferentially selected.

The patients' obstetric history at the time of admission (gravida, parity, abortion), age, height, weight, gestational age, routine obstetric measurements (fetal position, placental location, amniotic fluid volume, etc.), personal and family history were all recorded. Birth weight and Apgar scores of the newborns were also recorded.

The cesarean scar incision line was visually examined and scored. The scar incision score recorded as inwardly displaced (deplaced), at skin level (flat), or raised (keloid-like).

Stretch marks that form on the abdomen during pregnancy were evaluated and noted according to the proportion they cover when the abdomen was divided into four sections. Stretch mark scores recorded as follows: none for absence of stretch marks, 1/4 for quarter, 1/2 for half and 3/4 for one-third of the abdomen.Intra-abdominal adhesions in patients undergoing cesarean section were classified according to the Nair adhesion scoring system, regardless of prior ultrasound assessment.

Accordingly, the classification recorded as follows: Grade 0: absence of adhesions, Grade 1: presence of a single band of adhesion between the visceral peritoneum and the abdominal surface, Grade 2: presence of two bands of adhesion between the visceral peritoneum and the abdominal surface, Grade 3: presence of three or more bands of adhesion between the visceral peritoneum and the abdominal surface, Grade 4: presence of multiple dense adhesions. The presence of the sliding sign was evaluated as described by Baron et al..The probe was placed just above the transverse skin scar and the patient was asked to take a deep breath or cough in order for the uterus to be observed sliding caudally under the parietal peritoneum and fascia transversalis. Presence of the sliding sign was described "positive" when sliding of the uterus against the abdominal wall was observed. When no movement of the uterus under the fascia, the sliding sign was considered "negative".

The relationship of the bladder to the uterus, whether it was below or above the symphysis pubis were noted. The tissue between the uterus and bladder (vesicouterin thickness) was examined and mesasured.

Inclusion criteria

• 18-45 years
• viable singleton third-trimester (37 weeks of gestation or later) pregnancies
• history of at least one previous cesarean section

Exclusion criteria

• uterine anomalies,
• intra-abdominal cysts or myomas,
• multiple pregnancies,
• history of additional intra-abdominal surgery,
• history of steroid use, collagen disorders,
• placental adhesion or invasion anomalies.