{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,26]],"date-time":"2026-09-26T10:46:16Z","timestamp":1790419576083,"version":"4.1.0"},"reference-count":15,"publisher":"Wiley","issue":"6","license":[{"start":{"date-parts":[[2019,12,4]],"date-time":"2019-12-04T00:00:00Z","timestamp":1575417600000},"content-version":"vor","delay-in-days":3,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["obgyn.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Ultrasound in Obstet &amp; Gyne"],"published-print":{"date-parts":[[2019,12]]},"abstract":"<jats:title>ABSTRACT<\/jats:title><jats:sec><jats:title>Objectives<\/jats:title><jats:p>To describe a new first\u2010trimester sonographic sign, the \u2018crash sign\u2019, associated with fetal open spina bifida, and to evaluate its clinical usefulness in the first\u2010trimester diagnosis of spina bifida.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>This was a retrospective review of patients referred to three fetal medicine centers in the first trimester (11\u2009+\u20090 to 13\u2009+\u20096\u2009weeks) with suspected spina bifida. Spina bifida was confirmed by direct visualization of the spinal defect on ultrasound by two experts and, when possible, by fetal postmortem examination. Ultrasound images were reviewed for the presence of the crash sign, which is the posterior displacement of the mesencephalon and deformation against the occipital bone in the axial view. The first\u2010trimester ultrasound images of a mixed group of 10 cases and 40 control fetuses without spina bifida were assessed for the presence of the crash sign by two assessors blinded to the diagnosis.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>The crash sign was present in 48 out of 53 confirmed cases of spina bifida. Of these, 27 had isolated spina bifida and 21 had an associated anomaly. Of the five cases without the crash sign, one had isolated spina bifida and four had an associated anomaly. The crash sign was not reported in any of the control fetuses.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>We have described a new first\u2010trimester sonographic marker for the diagnosis of spina bifida. Our results suggest that the crash sign may be a useful tool in the first\u2010trimester detection of spina bifida. Prospective evaluation of the crash sign would be beneficial, ideally in a routine clinical screening ultrasound setting. Copyright \u00a9 2019 ISUOG. Published by John Wiley &amp; Sons Ltd.<\/jats:p><\/jats:sec>","DOI":"10.1002\/uog.20285","type":"journal-article","created":{"date-parts":[[2019,4,12]],"date-time":"2019-04-12T09:35:43Z","timestamp":1555061743000},"page":"740-745","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":59,"title":["Crash sign: new first\u2010trimester sonographic marker of spina bifida"],"prefix":"10.1002","volume":"54","author":[{"given":"F.","family":"Ushakov","sequence":"first","affiliation":[{"name":"Fetal Medicine Unit, Elizabeth Garrett Anderson Wing University College London Hospital  London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9182-9628","authenticated-orcid":false,"given":"A.","family":"Sacco","sequence":"additional","affiliation":[{"name":"Fetal Medicine Unit, Elizabeth Garrett Anderson Wing University College London Hospital  London UK"},{"name":"Institute for Women's Health University College London  London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1000-5804","authenticated-orcid":false,"given":"E.","family":"Andreeva","sequence":"additional","affiliation":[{"name":"Moscow Regions Research Institute of Obstetrics and Gynecology Medical\u2010Genetics Department  Moscow Russia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1079-3908","authenticated-orcid":false,"given":"S.","family":"Tudorache","sequence":"additional","affiliation":[{"name":"University of Medicine and Pharmacy Craiova Emergency University Hospital of Craiova  Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"T.","family":"Everett","sequence":"additional","affiliation":[{"name":"Fetal Medicine Unit, Elizabeth Garrett Anderson Wing University College London Hospital  London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0199-6140","authenticated-orcid":false,"given":"A. 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