Preoperative sonographic sliding sign for prediction of intra-abdominal adhesions before repeat cesarean delivery.

OBJECTIVE: To evaluate the usefulness of the uterine sliding sign for predicting intra-abdominal adhesions in women undergoing repeat cesarean section (CS) and the association of the sliding sign with other operative and neonatal outcomes. METHODS: A prospective cohort study was conducted among pregnant women with at least one previous CS. Transabdominal ultrasonography was performed and classified as a positive or negative sliding sign. Surgeons blinded to the sonographic results assessed intra-abdominal adhesions. The sensitivity, specificity, positive predictive value, and negative predictive value were calculated. Operative and neonatal outcomes of the positive and negative sliding sign groups were compared. Factors associated with intraoperative adhesions were also analyzed. RESULTS: A total of 380 women were recruited. The sensitivity and specificity of the uterine sliding sign to detect moderate-to-thick adhesions were 60.6% and 91.9%, respectively. A negative sliding sign was significantly associated with a higher incidence of adhesions, longer skin-to-delivery time, longer total operative time, and lower 5-min APGAR score in newborns. A negative sliding sign and history of two or more previous CS were significant predictors of moderate-to-thick adhesions. CONCLUSION: The uterine sliding sign is an independent predictor of intraoperative adhesions, with acceptable sensitivity and high specificity and negative predictive value.

Low-dose aspirin for prevention of preeclampsia: Implementation of the NICE guideline in Thailand.

AIM: To evaluate the effectiveness of a preeclampsia (PE) screening program using the National Institute for Health and Care Excellence (NICE) guideline in pregnant Thai women. METHODS: A total of 2552 pregnancies received antenatal care and were delivered at Songklanagarind Hospital between November 2016 and April 2020. PE screening with the NICE guideline was used to identify mothers at risk. In cases of positive screening results, a daily dose of 81 mg aspirin was prescribed. Pregnancy outcomes were compared with 2783 participants who had maternity care before the implementation of the screening program. The effectiveness of aspirin prophylaxis following the NICE guideline was assessed by a logistic regression model to compare the risk of PE development between before and after guidance. RESULTS: The screening positive rate by NICE was 8.3%. Of these, 77.36% of the participants received aspirin prophylaxis according to the NICE recommendation. After the implementation of the PE screening program, the incidence of PE slightly decreased (from 4.31% to 3.72%, p = 0.274). The chance of PE in pregnancies who had high-risk factors was reduced after using low-dose aspirin prophylaxis, even though the difference was not statistically significant. CONCLUSIONS: Screening with the NICE guidelines followed by prescription of low-dose aspirin (81 mg/day) was probably not an effective strategy for the prevention of PE in our population. Combining biophysical and biochemical markers to identify pregnant women who subsequently develop PE, concurrently with an increased dose of aspirin prophylaxis, may provide a better outcome in clinical practice.