Vesico-uterin Thickness and Sliding Sign in Term Pregnancies (sliding sign)

Comparision of Ultrasonographic Vesicouterin Thickness Measurement and Sliding Sign in Term Pregnancies With and Without Cesarean Surgery

In this study, our aim was to evaluate the relationship of the bladder to the uterus including vesicouterin thickness and sliding sign in term pregnancies with at least one previous cesarean section and compare to controls.

Study Overview

• Status: Completed
• Conditions: Term Pregnancy; Adhesion; Bladder; Sliding Sign; Vesicouterin Thickness; Adhesions Uterus
• Intervention / Treatment: Other: ultrasound evaluation

Detailed Description

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.

• Study Type: Interventional
• Enrollment (Actual): 117
• Phase: Not Applicable

Contacts and Locations

Study Locations

• Turkey (Türkiye)
  • Yuregir
    • Adana, Yuregir, Turkey (Türkiye), 01230
      • University of Heath and Science Adana City Hospital

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Adult
• Accepts Healthy Volunteers: Yes

Description

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.

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Diagnostic
• Allocation: Non-Randomized
• Interventional Model: Parallel Assignment
• Masking: None (Open Label)

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Active Comparator: intervention (study) group; repeated cesarean group	Other: ultrasound evaluation; 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".; Other Names: Sliding sign; vesico-uterin thickness
Active Comparator: control group; primigravid patients	Other: ultrasound evaluation; 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".; Other Names: Sliding sign; vesico-uterin thickness

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
sliding sign	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 study will end when a sufficient number of patients is reached.
Vesicouterin thickness	The tissue between the uterus and bladder (vesicouterin thickness) was examined and mesasured.	Approximately 6 months. The study will complete when required number of patients reached.

Collaborators and Investigators

• Sponsor: Adana City Training and Research Hospital
• Investigators: Principal Investigator: Gülsüm Uysal, Department of Obstetrics and Gynecology, University of Health and Science Adana City Training and Research Hospital, Adana, Turkey

Study record dates

Study Major Dates

• Study Start (Actual): January 1, 2024
• Primary Completion (Actual): June 30, 2024
• Study Completion (Actual): June 30, 2024

Study Registration Dates

• First Submitted: April 6, 2026
• First Submitted That Met QC Criteria: April 6, 2026
• First Posted (Actual): April 13, 2026

Study Record Updates

• Last Update Posted (Actual): April 21, 2026
• Last Update Submitted That Met QC Criteria: April 15, 2026
• Last Verified: December 1, 2023

More Information

Terms related to this study

• Keywords: sliding sign; Vesicouterin thickness; intra-abdominal adhesions; repeat Cesarean section
• Additional Relevant MeSH Terms: Pathologic Processes; Cicatrix; Fibrosis; Pathological Conditions, Signs and Symptoms; Tissue Adhesions
• Other Study ID Numbers: 3015/12.2023

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No