Easy sonographic differential diagnosis between intrauterine pregnancy and cesarean delivery scar pregnancy in the early first trimester

Intl J Gynecology & Obste

Timor-Trisch

Palacios‐Jaraquemada

et al. 2018

Section: Discussionmentioning

confidence: 99%

Changes in ultrasonography indicators of abnormally invasive placenta during pregnancy

Intl J Gynecology & Obste

Timor-Trisch

Palacios‐Jaraquemada

et al. 2018

“…Early first‐trimester ultrasound images from 6–8 weeks' gestation were retrieved from the computerized database of each referring hospital. All stored images showed the gestational sac or trophoblast within a Cesarean section scar and thus were labeled as CSP. Other ultrasound criteria used to confirm the diagnosis were the following: visualization of an empty uterine cavity as well as an empty endocervical canal, closed and empty cervical canal, presence of embryonic/fetal pole and/or yolk sac with or without heart activity and presence of a prominent and, at times, rich vascular pattern at or in the area of a scar in the presence of a positive pregnancy test.…”

Section: Methodsmentioning

confidence: 99%

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

Ultrasound in Obstet & Gyne

Forlani

Minneci

et al. 2018

Objective Ultrasound assessment of the relationship between the ectopic gestational sac and the endometrial line (cross-over sign; COS) Results Sixty-eight pregnancies were included in the study. Mean estimated blood loss was higher in AIP pregnancies with COS-1 than in those with COS-2+ (P = 0.039) or COS-2− (P = 0.01). Mean number of packed red blood cell units required during or after the operation was higher in women with COS-1 compared with those with COS-2+ (P

“…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%

“…(the 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 . (location of the center of the gestational sac below or above the midline of the uterus, i.e.…”

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

Ultrasound in Obstet & Gyne

Timor‐Tritsch

Forlani

et al. 2020

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 <...