{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,11]],"date-time":"2026-07-11T20:14:10Z","timestamp":1783800850799,"version":"3.55.0"},"reference-count":21,"publisher":"Wiley","license":[{"start":{"date-parts":[[2026,7,11]],"date-time":"2026-07-11T00:00:00Z","timestamp":1783728000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2026,7,11]],"date-time":"2026-07-11T00:00:00Z","timestamp":1783728000000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["J of Ultrasound Medicine"],"abstract":"<jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>Placenta accreta spectrum (PAS) is a complex obstetric condition associated with maternal morbidity and mortality. Urologic injuries complicate 15\u201320% of PAS deliveries during cesarean hysterectomy (CH). This study aimed to evaluate antenatal ultrasound markers for predicting intraoperative urologic tract (UT) injury during CH for PAS.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We conducted a multicenter, retrospective cohort analysis of singleton pregnancies with pathology\u2010confirmed PAS delivered at 2 large referral centers. Subjects were excluded if there were incomplete records, delivery outside of the centers, or lack of histopathology PAS confirmation. Ultrasonographic variables assessed included placental location, presence of previa or low\u2010lying placenta, presence of lacunae, loss of retroplacental clear zone, lower segment hypervascularity, bladder and uterine bulge, myometrial thinning, abnormal uterine\u2010bladder interface, and suspected depth of invasion. The primary outcome was the occurrence of any UT injury (ureteral or bladder) during CH. Univariate and multivariate analyses were performed to identify predictive factors for the primary outcome.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Of 358 subjects meeting inclusion criteria, 59 (16.5%) sustained a UT injury. Central previa was the only independent predictor of GU injury on adjusted analysis (aOR 4.08, 95% CI 1.39\u201312.13;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u2009.011). A pre\u2010specified central previa\u2009\u00d7\u2009suspected percreta interaction term was not statistically significant, indicating additive rather than synergistic risk. Individual ultrasound markers were not independently associated with GU injury (AUC 0.783).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Placental topography, specifically US findings of a central placenta previa and suspicion for percreta, was the main driver in predicting intra\u2010operative genitourinary injury during PAS deliveries. Multimodal imaging remains essential; however, targeted counseling and operative preparedness should be prioritized for patients with central previa and suspected percreta.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/jum.70371","type":"journal-article","created":{"date-parts":[[2026,7,11]],"date-time":"2026-07-11T19:50:49Z","timestamp":1783799449000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Antenatal Ultrasound Predictors of Urologic Tract Injury in Cesarean Hysterectomy for Placenta Accreta Spectrum"],"prefix":"10.1002","author":[{"given":"Matthew D.","family":"Mitts","sequence":"first","affiliation":[{"name":"Department of Obstetrics and Gynecology Baylor College of Medicine and Texas Children's Fetal Center  Houston Texas USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yamely H.","family":"Martinez","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology Baylor College of Medicine and Texas Children's Fetal Center  Houston Texas USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christina C.","family":"Reed","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology Baylor College of Medicine and Texas Children's Fetal Center  Houston Texas USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kayla E.","family":"Ireland","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology Baylor College of Medicine and Texas Children's Fetal Center  Houston Texas USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Georgia A.","family":"McCann","sequence":"additional","affiliation":[{"name":"Department Obstetrics and Gynecology University of Texas San Antonio  San Antonio Texas USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Claire","family":"Hoppenot","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology Baylor College of Medicine and Texas Children's Fetal Center  Houston Texas USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Amir","family":"Shamshisaz","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology Baylor College of Medicine and Texas Children's Fetal Center  Houston Texas USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hendrik A.","family":"Lombaard","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology Baylor College of Medicine and Texas Children's Fetal Center  Houston Texas USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael A.","family":"Belfort","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology Baylor College of Medicine and Texas Children's Fetal Center  Houston Texas USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2398-356X","authenticated-orcid":false,"given":"Michael D.","family":"Jochum","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology Baylor College of Medicine and Texas Children's Fetal Center  Houston Texas USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jessian L.","family":"Munoz","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology Baylor College of Medicine and Texas Children's Fetal Center  Houston Texas USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,7,11]]},"reference":[{"key":"e_1_2_7_2_1","doi-asserted-by":"crossref","first-page":"1529","DOI":"10.1056\/NEJMcp1709324","article-title":"Placenta accreta spectrum","volume":"378","author":"Silver 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(Kaunas)"},{"key":"e_1_2_7_9_1","doi-asserted-by":"crossref","first-page":"732","DOI":"10.1097\/AOG.0000000000005928","article-title":"4\u2010French aortic balloon occlusion in cesarean hysterectomy for placenta accreta spectrum disorder","volume":"145","author":"Munoz JL","year":"2025","journal-title":"Obstet Gynecol"},{"key":"e_1_2_7_10_1","doi-asserted-by":"crossref","first-page":"806","DOI":"10.1097\/AOG.0000000000004957","article-title":"Prophylactic ureteral stent placement and urinary injury during hysterectomy for placenta accreta spectrum","volume":"140","author":"Scaglione MA","year":"2022","journal-title":"Obstet Gynecol"},{"key":"e_1_2_7_11_1","doi-asserted-by":"crossref","DOI":"10.1016\/j.ajogmf.2023.101120","article-title":"Prophylactic ureteral stent placement for the prevention of genitourinary tract injury during hysterectomy for placenta accreta spectrum: systematic review and meta\u2010analysis","volume":"5","author":"Horgan R","year":"2023","journal-title":"Am J 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Study"],"short-title":[],"issued":{"date-parts":[[2026,7,11]]},"references-count":21,"alternative-id":["10.1002\/jum.70371"],"URL":"https:\/\/doi.org\/10.1002\/jum.70371","archive":["Portico"],"relation":{},"ISSN":["0278-4297","1550-9613"],"issn-type":[{"value":"0278-4297","type":"print"},{"value":"1550-9613","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,7,11]]},"assertion":[{"value":"2026-02-17","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-06-27","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-07-11","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"jum.70371"}}