{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,17]],"date-time":"2026-08-17T14:55:57Z","timestamp":1786978557338,"version":"build-2736575974"},"reference-count":15,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2017,6,7]],"date-time":"2017-06-07T00:00:00Z","timestamp":1496793600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["obgyn.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Ultrasound in Obstet & Gyne"],"published-print":{"date-parts":[[2017,7]]},"abstract":"ABSTRACT<\/jats:title>\n \n Objective<\/jats:title>\n \n Advances in prenatal imaging techniques have led to an increase in the diagnosis of Cesarean scar pregnancy (\n CSP<\/jats:styled-content>\n ). However, antenatal counseling when\n CSP<\/jats:styled-content>\n is diagnosed is challenging, and current evidence is derived mainly from small series reporting high rates of adverse maternal outcomes. The aim of this study was to ascertain the performance of prenatal ultrasound in predicting the natural history of\n CSP<\/jats:styled-content>\n using a new sonographic sign, the crossover sign (\n COS<\/jats:styled-content>\n ).\n <\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n \n This was a retrospective analysis of early first\u2010trimester (6\u20138 weeks' gestation) ultrasound images in women with morbidly adherent placenta (\n MAP<\/jats:styled-content>\n ) managed in the third trimester of pregnancy. The relationship between the gestational sac of the\n CSP<\/jats:styled-content>\n , anterior uterine wall and Cesarean scar, defined as the\n COS<\/jats:styled-content>\n , was analyzed to determine whether it could predict evolution in these cases. Odds ratios (\n ORs<\/jats:styled-content>\n ) were calculated and logistic regression analysis was performed to investigate the association between different types of\n COS<\/jats:styled-content>\n (\n COS<\/jats:styled-content>\n \u20101,\n COS<\/jats:styled-content>\n \u20102+ or\n COS<\/jats:styled-content>\n \u20102\u2013) and the occurrence of\n MAP<\/jats:styled-content>\n .\n <\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n \n Sixty\u2010eight pregnancies with\n MAP<\/jats:styled-content>\n were included. The risk of placenta percreta was significantly higher in pregnancies with\n COS<\/jats:styled-content>\n \u20101 than in those with\n COS<\/jats:styled-content>\n \u20102 (\n OR<\/jats:styled-content>\n , 6.67 (95%\n CI<\/jats:styled-content>\n , 1.3\u201333.3)). When evaluating the two variants of\n COS<\/jats:styled-content>\n \u20102 separately, the risk of placenta percreta was significantly higher in pregnancies with\n COS<\/jats:styled-content>\n \u20101\n vs<\/jats:italic>\n COS<\/jats:styled-content>\n \u20102+ (\n OR<\/jats:styled-content>\n , 5.83 (95%\n CI<\/jats:styled-content>\n , 1.1\u201330.2)) and this risk was even higher when comparing cases with\n COS<\/jats:styled-content>\n \u20101\n vs<\/jats:italic>\n COS<\/jats:styled-content>\n \u20102\u2013 (\n OR<\/jats:styled-content>\n , 12.0 (95%\n CI<\/jats:styled-content>\n , 1.9\u201375.7)). Logistic regression analysis showed that\n COS<\/jats:styled-content>\n \u20101 was associated independently with severe forms of\n MAP<\/jats:styled-content>\n , such as placenta percreta and increta (\n OR<\/jats:styled-content>\n , 12.85 (95%\n CI<\/jats:styled-content>\n , 2.0\u201384.0)), while\n COS<\/jats:styled-content>\n \u20102+ was associated independently with placenta accreta (\n OR<\/jats:styled-content>\n , 4.37 (95%\n CI<\/jats:styled-content>\n , 1.1\u201317.0)).\n <\/jats:p>\n <\/jats:sec>\n \n Conclusions<\/jats:title>\n \n Ultrasound assessment of the relationship between the gestational sac of a\n CSP<\/jats:styled-content>\n and the endometrial line (the\n COS<\/jats:styled-content>\n ) may help to determine whether a CSP will progress towards a less severe form of\n MAP<\/jats:styled-content>\n , amenable to postnatal treatment, and successful pregnancy outcome. Large prospective studies are needed to confirm our findings and elucidate the natural history of this condition. Copyright \u00a9 2016 ISUOG. Published by John Wiley & Sons Ltd.\n <\/jats:p>\n <\/jats:sec>","DOI":"10.1002\/uog.16216","type":"journal-article","created":{"date-parts":[[2016,7,15]],"date-time":"2016-07-15T11:20:51Z","timestamp":1468581651000},"page":"100-104","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":104,"title":["Natural history of Cesarean scar pregnancy on prenatal ultrasound: the crossover sign"],"prefix":"10.1002","volume":"50","author":[{"given":"G.","family":"Cali","sequence":"first","affiliation":[{"name":"Department of Obstetrics and Gynaecology Arnas Civico Hospital Palermo Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"F.","family":"Forlani","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynaecology Arnas Civico Hospital Palermo Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"I. E.","family":"Timor\u2010Tritsch","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynaecology, Division of Maternal\u2010Fetal Medicine New York University SOM New York NY USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"J.","family":"Palacios\u2010Jaraquemada","sequence":"additional","affiliation":[{"name":"Centre for Medical Education and Clinical Research (CEMIC) University Hospital Buenos Aires Argentina"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"G.","family":"Minneci","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynaecology Arnas Civico Hospital Palermo Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"F.","family":"D'Antonio","sequence":"additional","affiliation":[{"name":"Department of Clinical Medicine, Faculty of Health Sciences UiT\u2013The Arctic University of Norway Troms\u00f8 Norway"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2017,6,7]]},"reference":[{"key":"e_1_2_5_2_1","doi-asserted-by":"publisher","DOI":"10.1097\/01.AOG.0000207559.15715.98"},{"key":"e_1_2_5_3_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0002-9378(97)70463-0"},{"key":"e_1_2_5_4_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.placenta.2011.11.010"},{"key":"e_1_2_5_5_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajog.2004.12.074"},{"key":"e_1_2_5_6_1","doi-asserted-by":"publisher","DOI":"10.1002\/uog.13282"},{"key":"e_1_2_5_7_1","doi-asserted-by":"publisher","DOI":"10.1002\/uog.13426"},{"key":"e_1_2_5_8_1","doi-asserted-by":"publisher","DOI":"10.1002\/uog.14775"},{"key":"e_1_2_5_9_1","doi-asserted-by":"publisher","DOI":"10.1002\/uog.14950"},{"key":"e_1_2_5_10_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajog.2016.02.028"},{"key":"e_1_2_5_11_1","doi-asserted-by":"publisher","DOI":"10.1002\/uog.974"},{"key":"e_1_2_5_12_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajog.2016.03.010"},{"key":"e_1_2_5_13_1","doi-asserted-by":"publisher","DOI":"10.1002\/uog.14708"},{"key":"e_1_2_5_14_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajog.2012.04.018"},{"key":"e_1_2_5_15_1","unstructured":"K Benirschke P Kaufmann RN Baergen 2006 Springer\u2010Verlag New York NY"},{"key":"e_1_2_5_16_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jclinepi.2007.11.008"}],"container-title":["Ultrasound in Obstetrics & Gynecology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/api.wiley.com\/onlinelibrary\/tdm\/v1\/articles\/10.1002%2Fuog.16216","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/api.wiley.com\/onlinelibrary\/tdm\/v1\/articles\/10.1002%2Fuog.16216","content-type":"unspecified","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/obgyn.onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/uog.16216","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,9,24]],"date-time":"2023-09-24T09:03:05Z","timestamp":1695546185000},"score":1,"resource":{"primary":{"URL":"https:\/\/obgyn.onlinelibrary.wiley.com\/doi\/10.1002\/uog.16216"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2017,6,7]]},"references-count":15,"journal-issue":{"issue":"1","published-print":{"date-parts":[[2017,7]]}},"alternative-id":["10.1002\/uog.16216"],"URL":"https:\/\/doi.org\/10.1002\/uog.16216","archive":["Portico"],"relation":{},"ISSN":["0960-7692","1469-0705"],"issn-type":[{"value":"0960-7692","type":"print"},{"value":"1469-0705","type":"electronic"}],"subject":[],"published":{"date-parts":[[2017,6,7]]},"assertion":[{"value":"2016-04-07","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2016-07-08","order":1,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2017-06-07","order":2,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}