First‐trimester prediction of surgical outcome in abnormally invasive placenta using the cross‐over sign

Calì, Giuseppe; Forlani, F.; Minneci, G.; Foti, Francesca; Liberto, S. Di; Familiari, Alessandra; Scambia, Giovanni; D’Antonio, Francesco

doi:10.1002/uog.17440

Cited by 41 publications

(43 citation statements)

References 16 publications

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“…The importance of this classification system relies on the fact that it can be used to tailor the optimal surgical approach. Assessing the topography of placental invasion has only recently been reported in the literature . In the present study, signs of vascular invasion of the parametria, identified using color Doppler ultrasonography were reported in no images obtained at 6–9 weeks of pregnancy, in 18.1% of those obtained at 11–14 weeks, and 47.6% of those taken during both the second and third trimesters; further, the visualization of vascular invasion of the parametria was more common in patients with placenta percreta compared with placenta accreta/increate among images taken during the second and third trimesters.…”

Section: Discussionsupporting

confidence: 42%

“…Kaelin Agten et al . showed that cesarean scar pregnancy implanted “on the scar”, defined as a placenta implanted partially or fully on top of a well healed scar, demonstrated substantially better outcomes compared with patients with the cesarean scar pregnancy implanted into the niche of a deficient or dehiscent scar, whereas Cali et al . showed that the relationship between the gestational sac of the cesarean scar pregnancy, the previous cesarean scar, and the anterior uterine wall thickness could be used to predict not only the evolution of the cesarean scar pregnancy towards the most severe types of AIP, but also clinical outcomes among these women.…”

Section: Discussionmentioning

confidence: 99%

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Changes in ultrasonography indicators of abnormally invasive placenta during pregnancy

Calì

Timor-Trisch

Palacios‐Jaraquemada

et al. 2018

Intl J Gynecology & Obste

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Section: Discussionsupporting

confidence: 42%

Section: Discussionmentioning

confidence: 99%

Changes in ultrasonography indicators of abnormally invasive placenta during pregnancy

Calì

Timor-Trisch

Palacios‐Jaraquemada

et al. 2018

Intl J Gynecology & Obste

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“…It has been shown recently that early first‐trimester (5–7 weeks' gestation) ultrasound assessment can predict the possibility of developing PAS disorder in women at high risk for this anomaly, thus supporting the role of early sonographic evaluation as a potential early predictor of this complication.…”

Section: Introductionmentioning

confidence: 87%

“…Early first‐trimester ultrasound images, obtained between 5 and 7 weeks of gestation, were retrieved from the computerized database of each referring hospital. The relationship between the position of the gestational sac and the prior Cesarean scar (CS) was assessed according to three sonographic markers reported by Calí et al . (the crossover sign (COS)), Kaelin Agten et al .…”

Section: Methodsmentioning

confidence: 99%

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Value of first‐trimester ultrasound in prediction of third‐trimester sonographic stage of placenta accreta spectrum disorder and surgical outcome

Calì

Timor‐Tritsch

Forlani

et al. 2020

Ultrasound in Obstet & Gyne

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Objectives To explore whether early first‐trimester ultrasound can predict the third‐trimester sonographic stage of placenta accreta spectrum (PAS) disorder and to elucidate whether combining first‐trimester ultrasound findings with the sonographic stage of PAS disorder can stratify the risk of adverse surgical outcome in women at risk for PAS disorder. Methods This was a retrospective analysis of prospectively collected data from women with placenta previa, and at least one previous Cesarean delivery (CD) or uterine surgery, for whom early first‐trimester (5–7 weeks' gestation) ultrasound images could be retrieved. The relationship between the position of the gestational sac and the prior CD scar was assessed using three sonographic markers for first‐trimester assessment of Cesarean scar (CS) pregnancy, reported by Calí et al. (crossover sign (COS)), Kaelin Agten et al. (implantation of the gestational sac on the scar vs in the niche of the CS) and Timor‐Tritsch et al. (position of the center of the gestational sac below vs above the midline of the uterus), by two different examiners blinded to the final diagnosis and clinical outcome. The primary aim of the study was to explore the association between first‐trimester ultrasound findings and the stage of PAS disorder on third‐trimester ultrasound. Our secondary aim was to elucidate whether the combination of first‐trimester ultrasound findings and sonographic stage of PAS disorder can predict surgical outcome. Logistic regression analysis and area under the receiver‐operating‐characteristics curve (AUC) were used to analyze the data. Results One hundred and eighty‐seven women with vasa previa were included. In this cohort, 79.6% (95% CI, 67.1–88.2%) of women classified as COS‐1, 94.4% (95% CI, 84.9–98.1%) of those with gestational‐sac implantation in the niche of the prior CS and 100% (95% CI, 93.4–100%) of those with gestational sac located below the uterine midline, on first‐trimester ultrasound, were affected by the severest form of PAS disorder (PAS3) on third‐trimester ultrasound. On multivariate logistic regression analysis, COS‐1 (odds ratio (OR), 7.9 (95% CI, 4.0–15.5); P < 0.001), implantation of the gestational sac in the niche (OR, 29.1 (95% CI, 8.1–104); P < 0.001) and location of the gestational sac below the midline of the uterus (OR, 38.1 (95% CI, 12.0–121); P < 0.001) were associated independently with PAS3, whereas parity (P = 0.4) and the number of prior CDs (P = 0.5) were not. When translating these figures into diagnostic models, first‐trimester diagnosis of COS‐1 (AUC, 0.94 (95% CI, 0.91–0.97)), pregnancy implantation in the niche (AUC, 0.92 (95% CI, 0.89–0.96)) and gestational sac below the uterine midline (AUC, 0.92 (95% CI, 0.88–0.96)) had a high predictive accuracy for PAS3. There was an adverse surgical outcome in 22/187 pregnancies and it was more common in women with, compared to those without, COS‐1 (P < 0.001), gestational‐sac implantation in the niche (P < 0.001) and gestational‐sac position below the uterine midline (P <...

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Abnormal placenta implantation. Integration between first‐ and third‐trimester imaging in predicting the severity of Placenta Accreta Spectrum (PAS) disorders

D’Antonio

Calagna

Tinari

et al. 2022

J of Clinical Ultrasound

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Placenta accreta spectrum (PAS) disorders are pathological conditions correlated to a high risk of adverse maternal surgical outcomes, especially if not diagnosed. In the last 10 years, the literature interest for prenatal diagnosis of PAS disorders has been noticeably greater. More recently, significant progression in prenatal imaging techniques permitted an increase of early identified cases and a more accurate diagnosis of these anomalies, especially in women with multiple risk factors. The aim of this chapter is to give an overhaul on prenatal diagnosis of PAS disorders throughout gestation and to report whether integration between first-and third-trimester ultrasound can predict the development and severity of these anomalies.

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First‐trimester prediction of surgical outcome in abnormally invasive placenta using the cross‐over sign

Cited by 41 publications

References 16 publications

Changes in ultrasonography indicators of abnormally invasive placenta during pregnancy

Changes in ultrasonography indicators of abnormally invasive placenta during pregnancy

Value of first‐trimester ultrasound in prediction of third‐trimester sonographic stage of placenta accreta spectrum disorder and surgical outcome

Abnormal placenta implantation. Integration between first‐ and third‐trimester imaging in predicting the severity of Placenta Accreta Spectrum (PAS) disorders

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