The clinical outcome of cesarean scar pregnancies implanted “on the scar” versus “in the niche”

Agten, Andrea Kaelin; Calì, Giuseppe; Monteagudo, Ana; Oviedo, Johana D.; Ramos, Joanne; Timor‐Tritsch, I. E.

doi:10.1016/j.ajog.2017.01.019

Cited by 140 publications

(151 citation statements)

References 33 publications

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“…Recent studies indicate a relation between long-term outcomes and the occurrence of a niche in the uterine caesarean scar. Presence of a niche and small RMT may function as an intermediate for long-term outcomes, as they are related to gynaecological and reproductive outcomes such as postmenstrual spotting 4,5 , uterine dehiscence 7 or rupture 8 , a higher incidence of complications when caesarean scar pregnancy occurs 9 , placental adherence problems 10 and failure of trial of labour 11 . A niche is defined as a triangular anechoic area at the site of the previous uterine caesarean incision 6 and can best be visualised with saline or gel contrast hysterosonography.…”

Section: Introductionmentioning

confidence: 99%

Uterine caesarean closure techniques affect ultrasound findings and maternal outcomes: a systematic review and meta‐analysis

Stegwee

Jordans

Voet

et al. 2018

BJOG

107

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Double-layer unlocked sutures are preferable to single-layer locked sutures regarding RMT, healing ratio and dysmenorrhoea. Excluding the decidua seems to result in higher niche prevalence. As thin residual myometrium or niches may serve as intermediates for gynaecological and reproductive outcomes, future studies should focus on these outcomes. TWEETABLE ABSTRACT: #Uterineclosuretechniques after #caesarean affect #longtermoutcomes.

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Section: Introductionmentioning

confidence: 99%

Uterine caesarean closure techniques affect ultrasound findings and maternal outcomes: a systematic review and meta‐analysis

Stegwee

Jordans

Voet

et al. 2018

BJOG

107

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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%

“…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 . ( implantation of the gestational sac on the scar vs in the niche of the CS) and Timor‐Tritsch 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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“…showed that a CSP implanted within a defect scar (‘in the niche’) resulted in more severe AIP, and Cali et al . showed that the relationship between the gestational sac and the endometrial line (crossover sign) in CSP is useful in predicting the evolution of CSP towards different types of AIP. Ultrasound has a good diagnostic accuracy in detecting AIP in the first trimester.…”

Section: Pathophysiology Of Cspmentioning

confidence: 99%

Cesarean Scar Pregnancy Registry: an international research platform

Agten

Monteagudo

Timor‐Tritsch

et al. 2020

Ultrasound in Obstet & Gyne

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The clinical outcome of cesarean scar pregnancies implanted “on the scar” versus “in the niche”

Cited by 140 publications

References 33 publications

Uterine caesarean closure techniques affect ultrasound findings and maternal outcomes: a systematic review and meta‐analysis

Uterine caesarean closure techniques affect ultrasound findings and maternal outcomes: a systematic review and meta‐analysis

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

Cesarean Scar Pregnancy Registry: an international research platform

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