Objective

With the rate of repeated cesarean sections on the rise, intraperitoneal adhesions caused by repeated cesareans could give rise to maternal morbidity during delivery. As a result, it's critical to have the ability to predict adhesions. The current meta-analysis aims to determine if intraperitoneal adhesions are likely to be present based on the characteristics of the cesarean scar, striae gravidarum, and sliding sign.

Materials and methods

We systematically searched electronic databases before retrieving articles up until October 13th, 2022 for analysis. After data extraction and literature screening, we first performed a quality assessment using the QUADAS-2 score system. Following that, a bivariate random-effect meta-analysis model was used to obtain the combined diagnostic and predictive values. To pinpoint the origins of heterogeneity, we conducted a subgroup analysis. Fagan's Nomogram was used to validate the clinical utility. Sensitivity analysis was used to gauge the reliability of each included study, and Egger's test and funnel plot asymmetry was used to investigate publication bias.

Results

25 studies totaling 1840 patients with intra-abdominal adhesions and 2501 controls without adhesions were included in the systematic review. Diagnostic values from 8 studies regarding skin characteristics were combined, and the results for depressed scar showed: sensitivity[95 %CI] = 0.38[0.34–0.42]; Specificity[95 %CI] = 0.88[0.85–0.90]; DOR[95 %CI] = 4.78[2.50–9.13]; AUC = 0.65. Negative sliding sign from 7 studies, although not showing a diagnostic difference between cases and controls, had excellent predictive values: sensitivity[95 %CI] = 0.71[0.65–0.77]; Specificity[95 %CI] = 0.87[0.85–0.89]; DOR[95 %CI] = 6.88[0.6–78.9]; AUC = 0.77. Subgroup analysis illustrated non-Turkish studies to reveal more significant associations than Turkish studies.

Conclusion

Our meta-analysis found that the occurrence of adhesions can be predicted by the characteristics of abdominal wounds, particularly depressed scar, and scar width, as well as a negative sliding sign following a previous cesarean section.

中文翻译：

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重复剖宫产腹腔粘连的预测：系统评价和荟萃分析

客观的

随着重复剖宫产率的上升，重复剖宫产引起的腹腔粘连可能会增加产妇分娩时的发病率。因此，预测粘连的能力至关重要。目前的荟萃分析旨在根据剖宫产疤痕、妊娠纹和滑动征的特征来确定是否可能存在腹膜内粘连。

材料和方法

我们系统地检索了电子 数据库，然后 检索截至 2022 年 10 月 13 日的文章进行分析。经过数据提取和文献筛选后，我们首先使用QUADAS-2评分系统进行质量评估。随后，使用双变量随机效应荟萃分析模型来获得组合的诊断和预测值。为了查明异质性的根源，我们进行了亚组分析。费根列线图用于验证临床实用性。敏感性分析用于衡量每项纳入研究的可靠性，艾格检验和漏斗图不对称性用于调查发表偏倚。

结果

系统评价纳入了 25 项研究，总计 1840 名腹腔粘连患者和 2501 名无腹腔粘连对照患者。综合8项关于皮肤特征的研究的诊断值，凹陷疤痕的结果显示：敏感性[95%CI] = 0.38[0.34–0.42]；特异性[95%CI] = 0.88[0.85–0.90]；DOR[95%CI] = 4.78[2.50–9.13]；曲线下面积 = 0.65。7 项研究的负滑动征虽然没有显示病例和对照之间的诊断差异，但具有出色的预测价值：敏感性[95%CI] = 0.71[0.65–0.77]；特异性[95%CI] = 0.87[0.85–0.89]；DOR[95%CI] = 6.88[0.6–78.9]；曲线下面积 = 0.77。亚组分析表明，非土耳其研究比土耳其研究揭示了更显着的关联。

结论

我们的荟萃分析发现，粘连的发生可以通过腹部伤口的特征，特别是凹陷的疤痕、疤痕宽度以及 先前剖腹产后的负滑动征来预测。