{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,23]],"date-time":"2026-08-23T10:58:35Z","timestamp":1787482715457,"version":"build-2736575974"},"reference-count":38,"publisher":"Wiley","issue":"4","license":[{"start":{"date-parts":[[2020,3,31]],"date-time":"2020-03-31T00:00:00Z","timestamp":1585612800000},"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 &amp; Gyne"],"published-print":{"date-parts":[[2020,4]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>To explore whether early first\u2010trimester ultrasound can predict the third\u2010trimester sonographic stage of placenta accreta spectrum (PAS) disorder and to elucidate whether combining first\u2010trimester ultrasound findings with the sonographic stage of PAS disorder can stratify the risk of adverse surgical outcome in women at risk for PAS disorder.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      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\u2010trimester (5\u20137\u2009weeks' 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\u2010trimester assessment of Cesarean scar (CS) pregnancy, reported by Cal\u00ed\n                      <jats:italic>et al.<\/jats:italic>\n                      (crossover sign (COS)), Kaelin Agten\n                      <jats:italic>et al.<\/jats:italic>\n                      (implantation of the gestational sac on the scar\n                      <jats:italic>vs<\/jats:italic>\n                      in the niche of the CS) and Timor\u2010Tritsch\n                      <jats:italic>et al.<\/jats:italic>\n                      (position of the center of the gestational sac below\n                      <jats:italic>vs<\/jats:italic>\n                      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\u2010trimester ultrasound findings and the stage of PAS disorder on third\u2010trimester ultrasound. Our secondary aim was to elucidate whether the combination of first\u2010trimester ultrasound findings and sonographic stage of PAS disorder can predict surgical outcome. Logistic regression analysis and area under the receiver\u2010operating\u2010characteristics curve (AUC) were used to analyze the \ndata.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      One hundred and eighty\u2010seven women with vasa previa were included. In this cohort, 79.6% (95%\u2009CI, 67.1\u201388.2%) of women classified as COS\u20101, 94.4% (95%\u2009CI, 84.9\u201398.1%) of those with gestational\u2010sac implantation in the niche of the prior CS and 100% (95%\u2009CI, 93.4\u2013100%) of those with gestational sac located below the uterine midline, on first\u2010trimester ultrasound, were affected by the severest form of PAS disorder (PAS3) on third\u2010trimester ultrasound. On multivariate logistic regression analysis, COS\u20101 (odds ratio (OR), 7.9 (95%\u2009CI, 4.0\u201315.5);\n                      <jats:italic>P<\/jats:italic>\n                      \u2009&lt;\u20090.001), implantation of the gestational sac in the niche (OR, 29.1 (95%\u2009CI, 8.1\u2013104);\n                      <jats:italic>P<\/jats:italic>\n                      \u2009&lt;\u20090.001) and location of the gestational sac below the midline of the uterus (OR, 38.1 (95%\u2009CI, 12.0\u2013121);\n                      <jats:italic>P<\/jats:italic>\n                      \u2009&lt;\u20090.001) were associated independently with PAS3, whereas parity (\n                      <jats:italic>P<\/jats:italic>\n                      \u2009=\u20090.4) and the number of prior CDs (\n                      <jats:italic>P<\/jats:italic>\n                      \u2009=\u20090.5) were not. When translating these figures into diagnostic models, first\u2010trimester diagnosis of COS\u20101 (AUC, 0.94 (95%\u2009CI, 0.91\u20130.97)), pregnancy implantation in the niche (AUC, 0.92 (95%\u2009CI, 0.89\u20130.96)) and gestational sac below the uterine midline (AUC, 0.92 (95%\u2009CI, 0.88\u20130.96)) 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\u20101 (\n                      <jats:italic>P<\/jats:italic>\n                      \u2009&lt;\u20090.001), gestational\u2010sac implantation in the niche (\n                      <jats:italic>P<\/jats:italic>\n                      \u2009&lt;\u20090.001) and gestational\u2010sac position below the uterine midline (\n                      <jats:italic>P<\/jats:italic>\n                      \u2009&lt;\u20090.001). On multivariate logistic regression analysis, third\u2010trimester ultrasound diagnosis of PAS3 (OR, 4.3 (95%\u2009CI, 2.1\u201317.3)) and first\u2010trimester diagnosis of COS\u20101 (OR, 7.9 (95%\u2009CI, 4.0\u201315.5);\n                      <jats:italic>P<\/jats:italic>\n                      \u2009&lt;\u20090.001), pregnancy implantation in the niche (OR, 29.1 (95%\u2009CI, 8.1\u201379.0);\n                      <jats:italic>P<\/jats:italic>\n                      \u2009&lt;\u20090.001) and position of the sac below the uterine midline (OR, 6.6 (95%\u2009CI, 3.9\u201316.2);\n                      <jats:italic>P<\/jats:italic>\n                      \u2009&lt;\u20090.001) were associated independently with adverse surgical outcome. When combining the sonographic coordinates of the three first\u2010trimester imaging markers, we identified an area we call high\u2010risk\u2010for\u2010PAS triangle, which may enable an easy visual perception and application of the three methods to prognosticate the risk for CS pregnancy and PAS disorder, although it requires validation in large prospective studies.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Early first\u2010trimester sonographic assessment of pregnancies with previous CD can predict reliably ultrasound stage of PAS disorder. Combination of findings on first\u2010trimester ultrasound with second\u2010 and third\u2010trimester ultrasound examination can stratify the surgical risk in women affected by a PAS disorder. Copyright \u00a9 2019 ISUOG. Published by John Wiley &amp; Sons Ltd.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/uog.21939","type":"journal-article","created":{"date-parts":[[2019,12,2]],"date-time":"2019-12-02T15:18:08Z","timestamp":1575299888000},"page":"450-459","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":66,"title":["Value of first\u2010trimester ultrasound in prediction of third\u2010trimester sonographic stage of placenta accreta spectrum disorder and surgical outcome"],"prefix":"10.1002","volume":"55","author":[{"given":"G.","family":"Cal\u00ed","sequence":"first","affiliation":[{"name":"Department of Obstetrics and Gynaecology Azienda Ospedaliera Villa Sofia Cervello  Palermo Italy"},{"name":"Department of Obstetrics and Gynaecology Arnas Civico Hospital  Palermo Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9774-3107","authenticated-orcid":false,"given":"I. E.","family":"Timor\u2010Tritsch","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynaecology, Division of Maternal\u2013Fetal Medicine New York University SOM  New York NY USA"}],"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":"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":"A.","family":"Monteagudo","sequence":"additional","affiliation":[{"name":"Department of Obstetrics Gynecology and Reproductive Science, Icahn School of Medicine at Mount Sinai  New York NY USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"A. Kaelin","family":"Agten","sequence":"additional","affiliation":[{"name":"Fetal Medicine Unit, St George's University Hospitals NHS Foundation Trust, University of London  London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"M. E.","family":"Flacco","sequence":"additional","affiliation":[{"name":"Department of Medical Sciences University of Ferrara  Ferrara Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2802-7670","authenticated-orcid":false,"given":"A.","family":"Khalil","sequence":"additional","affiliation":[{"name":"Fetal Medicine Unit, St George's University Hospitals NHS Foundation Trust, University of London  London UK"},{"name":"Vascular Biology Research Centre, Molecular and Clinical Sciences Research Institute, St George's University of London  London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6880-7407","authenticated-orcid":false,"given":"D.","family":"Buca","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynaecology University of Chieti  Chieti 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