The Jellyfish Sign: A New Sonographic Cervical Marker to Predict Maternal Morbidity in Abnormally Invasive Placenta Previa

Bertucci, Emma; Sileo, Filomena Giulia; Grandi, Giovanni; Fenu, V.; Cani, C.; Mancini, Luciano; Mataca, Ema; Facchinetti, Fabio

doi:10.1055/s-0043-119872

Cited by 8 publications

(6 citation statements)

References 28 publications

(25 reference statements)

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“…Previous studies reported that the cervical length before delivery showed association with massive PPH in pregnancies with PP [23]. A new sonographic jellyfish sign, the absence of the normal linear demarcation between the placenta previa and the cervix, was also reported to correlate with maternal complications [24]. For patients with PP, the cervix was also included in the segmentation, as illustrated in Fig.…”

Section: Image Segmentationmentioning

confidence: 95%

Radiomics analysis of placenta on T2WI facilitates prediction of postpartum haemorrhage: A multicentre study

Yao

Liu

et al. 2019

EBioMedicine

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BackgroundIdentification of pregnancies with postpartum haemorrhage (PPH) antenatally rather than intrapartum would aid delivery planning, facilitate transfusion requirements and decrease maternal complications. MRI has been increasingly used for placenta evaluation. Here, we aim to build a nomogram incorporating both clinical and radiomic features of placenta to predict the risk for PPH in pregnancies during caesarian delivery (CD).MethodsA total of 298 pregnant women were retrospectively enrolled from Henan Provincial People's Hospital (training cohort: n = 207) and from The Third Affiliated Hospital of Zhengzhou University (external validation cohort: n = 91). These women were suspected with placenta accreta spectrum (PAS) disorders and underwent MRI for placenta evaluation. All of them underwent CD and were singleton. PPH was defined as more than 1000 mL estimated blood loss (EBL) during CD. Radiomic features were selected based on their correlations with EBL. Radiomic, clinical, radiological, clinicoradiological and clinicoradiomic models were built to predict the risk of PPH for each patient. The model with the best prediction performance was validated with its discrimination ability, calibration curve and clinical application.FindingsThirty-five radiomic features showed strong correlation with EBL. The clinicoradiomic model resulted in the best discrimination ability for risk prediction of PPH, with AUC of 0.888 (95% CI, 0.844–0.933) and 0.832 (95% CI, 0.746–0.913), sensitivity of 91.2% (95% CI, 85.8%-96.7%) and 97.6% (95% CI, 92.7%-100%) in the training and validation cohort respectively. For patients with severe PPH (EBL more than 2000 mL), 53 out of 55 pregnancies (96.4%) in the training cohort and 18 out of 18 (100%) pregnancies in the validation cohort were identified by the clinicoradiomic model. The model performed better in patients without placenta previa (PP) than in patients with PP, with AUC of 0.983 compared with 0.867, sensitivity of 100% compared with 90.8% in the training cohort, AUC of 0.832 compared with 0.815, sensitivity of 97.6% compared with 97.2% in the validation cohort.InterpretationThe clinicoradiomic model incorporating both prenatal clinical factors and radiomic signature of placenta on T2WI showed good performance for risk prediction of PPH. The predictive model can identify severe PPH with high sensitivity and can be applied in patients with and without PP.

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Section: Image Segmentationmentioning

confidence: 95%

Radiomics analysis of placenta on T2WI facilitates prediction of postpartum haemorrhage: A multicentre study

Yao

Liu

et al. 2019

EBioMedicine

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“…Transvaginal sonographic assessment of the cervix in women with placenta previa has been suggested recently by some authors. Bertucci et al 30 introduced a new sonographic sign for the prediction of maternal morbidity in women with abnormally invasive placenta previa, the so-called jellyfish sign, defined as the absence of the normal linear demarcation between the placenta previa and the cervix. Although based on a small number of cases, their pilot study yielded a high specificity for both PAS disorder (95%) and need for Cesarean hysterectomy (96.2%).…”

Section: Discussionmentioning

confidence: 99%

Intracervical lakes as sonographic marker of placenta accreta spectrum disorder in patients with placenta previa or low‐lying placenta

Pasquo

Ghi

Calì

et al. 2020

Ultrasound in Obstet & Gyne

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Objective To evaluate the diagnostic accuracy of a new ultrasound sign, intracervical lakes (ICL), in predicting the presence of placenta accreta spectrum (PAS) disorder and delivery outcome in patients with placenta previa or low‐lying placenta. Methods This was a retrospective multicenter study of women with placenta previa or low‐lying placenta at ≥ 26 weeks' gestation, who were referred to three Italian tertiary units from January 2015 to September 2018. The presence of ICL, defined as tortuous anechoic spaces within the cervix which appeared to be hypervascular on color Doppler, was evaluated on ultrasound images obtained at the time of referral. The primary aim was to explore the diagnostic accuracy of ICL in detecting the presence and depth of PAS disorder. The secondary aim was to explore the accuracy of this sign in predicting total estimated blood loss, antepartum bleeding, major postpartum hemorrhage at the time of Cesarean section and need for Cesarean hysterectomy. The diagnostic accuracy of ICL in combination with typical sonographic signs of PAS disorder, was assessed by computing summary estimates of sensitivity, specificity, positive and negative predictive values, positive and negative likelihood ratios and diagnostic odds ratios (DOR). Results A total of 332 women with placenta previa or low‐lying placenta were included in the analysis, with a median maternal age of 33.0 (interquartile range, 29.0–37.0) years. ICL were noted in 15.1% of patients. On logistic regression analysis, the presence of ICL was associated independently with major postpartum hemorrhage (odds ratio (OR), 3.3 (95% CI, 1.6–6.5); P < 0.001), Cesarean hysterectomy (OR, 7.0 (95% CI, 2.1–23.9); P < 0.001) and placenta percreta (OR, 2.8 (95% CI, 1.3–5.8); P ≤ 0.01), but not with the presence of any PAS disorder (OR, 1.6 (95% CI, 0.7–3.5); P = 0.2). Compared with the group of patients without ultrasound signs of PAS disorder, the presence of at least one typical sonographic sign of PAS disorder in combination with ICL had a DOR of 217.2 (95% CI, 27.7–1703.4; P < 0.001) for placenta percreta and of 687.4 (95% CI, 121.4–3893.0; P < 0.001) for Cesarean hysterectomy. Conclusion ICL may represent a marker of deep villus invasion in women with suspected PAS disorder on antenatal sonography and anticipate the occurrence of severe maternal morbidity. Copyright © 2019 ISUOG. Published by John Wiley & Sons Ltd.

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“…The sonography was Performed transabdominal by setting the probe vertically without pressure on the pubic symphysis with a full bladder. After locating the placenta (especially placenta previa) and its involvements, the most bulging volume behind the bladder(area, perimeter, and volume), the lacune(diameter, length, number, and surface of the largest lacunae obtained by multiplying the length by the width), the most considerable thickness of placenta on the cervix in patients with placenta previa, the most considerable thickness of the placenta behind the bladder, the Jelly sh sign (7), and sponge cervix (10) were evaluated. Also, transvaginal ultrasonography is considered the bulging of the Cervix in its canal and sponge cervix.…”

Section: Methodsmentioning

confidence: 99%

“…Continuously, various studies have been introducing novel markers in the diagnosis of PAS; for example, the presence of Jelly sh sign, de ned as the absence of a normal linear layer between the placenta and cervix is associated with the amount of bleeding, the need for red blood cell and plasma transfusion, hospitalization in ICU, duration hospitalization and increased rate of hysterectomy during cesarean section (7); also, the presence of intracervical lakes de ned as anechoic area and hypervascular tortuosity inside the cervix can increase the rate of percreta and cesarean hysterectomy accompanied by typical symptoms of PAS (8). As a requirement in standardizing ultrasound markers in diagnosing PAS, The Fetal Medicine Foundation (FMF) 2021 de ned some markers, including the number of placenta lacunae, absence of posterior placental hypoechoic area, thin posterior placental myometrium, hypervascularity of posterior bladder or placental, etc.…”

Section: Introductionmentioning

confidence: 99%

Prediction of bleeding in placenta accrete spectrum with lacunar surface: a novel aspect

Vahdani,

Shabani,

Haddadi

et al. 2024

J Ultrasound

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Background:Diagnosing the placenta accreta spectrum for suspicious pregnant women is crucial to prevent morbidities and mortalities among them. We aim to evaluate the novel ultrasonography markers for these patients in diagnosis and predicting prognosis. Method and Materials:This cross-sectional study was performed in a referral academic hospital. The population was 51 pregnant women suspicious of PAS. Their primary information and medical and surgical histories were documented. Then the ultrasonography markers, including the most bulging volume behind the bladder(area, perimeter, and volume), the Lacune(diameter, length, number, and surface of the largest lacuna obtained by multiplying the length by the width), the most considerable thickness of placenta on the cervix in patients with placenta previa, the most considerable thickness of the placenta behind the bladder, the Jelly sh sign, and sponge cervix were evaluated. Their comparison to the severity of the bleeding, the rate of the hysterectomy, and the following pathology of the PAS were analyzed.Result: 17(33.3%) of patients had severe bleeding. The diameter, length, and surface of the largest lacunae limited to women with severe bleeding were 13.50(5.5-21), 20.50(11-56), 273.00(60-1176), and they were 11.00(5-24), 16.25(10-39), and 176.25 (50-744) for women without severe bleeding (P-value= 0.039, 0.027, 0.021). 13(76.5%) women with severe bleeding had Jelly sh signs,16(94.2%) had bulging on the cervix, and 10(58.8%) had sponge cervix (P-value=0.046, 0.036, 0.006). 34 (66.66%) patients needed hysterectomy. The diameter, length, and surface of the largest lacunae limited to women with hysterectomy were 11.00 (5-24), 17.50(10-39), 181.50 (50-744), and they were 15.00 (12-18), 20.50(14-27), and 327.00(168-1176) for women without hysterectomy (P-value= 0.012, 0.070, 0.021). 24(70.6%) women with hysterectomy had Jelly sh signs, 29(85.3%) of them had bulging on the cervix, and 15(44.1%) had sponge cervix (P-value=0.05, 0.036,0.028 ). the cut-off associated with the Lacunar surface was 163.5 Its sensitivity was 80%. Its speci city was 48% (p-value=0.021). Conclusion:The presence of single large lacunae could be a suitable predictive factor for bleeding in the placenta accreta spectrum; also, there are some other US criteria, including the presence of sponge cervix and Jelly sh sign as predictive factors for consequences in this spectrum, including hysterectomy. Key MessageThe presence of single large lacunae could be a suitable predictive factor for bleeding in the placenta accrete spectrum; also, there are some other US criteria, including the presence of sponge cervix and Jelly sh sign, are predictive factors for consequences in this spectrum including hysterectomy.

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The Jellyfish Sign: A New Sonographic Cervical Marker to Predict Maternal Morbidity in Abnormally Invasive Placenta Previa

Cited by 8 publications

References 28 publications

Radiomics analysis of placenta on T2WI facilitates prediction of postpartum haemorrhage: A multicentre study

Radiomics analysis of placenta on T2WI facilitates prediction of postpartum haemorrhage: A multicentre study

Intracervical lakes as sonographic marker of placenta accreta spectrum disorder in patients with placenta previa or low‐lying placenta

Prediction of bleeding in placenta accrete spectrum with lacunar surface: a novel aspect

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