{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,26]],"date-time":"2026-10-26T01:14:56Z","timestamp":1792977296888,"version":"4.5.0"},"reference-count":64,"publisher":"Wiley","issue":"4","license":[{"start":{"date-parts":[[2022,4,1]],"date-time":"2022-04-01T00:00:00Z","timestamp":1648771200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":["obgyn.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Ultrasound in Obstet &amp;amp; Gyne"],"published-print":{"date-parts":[[2022,4]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>To develop a standardized sonographic evaluation and reporting system for Cesarean scar pregnancy\u00a0(CSP) in the first trimester, for use by both general gynecology and expert clinics.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A modified Delphi procedure was carried out, in which 28 international experts in obstetric and gynecological ultrasonography were invited to participate. Extensive experience in the use of ultrasound to evaluate Cesarean section (CS) scars in early pregnancy and\/or publications concerning CSP or niche evaluation was required to participate. Relevant items for the detection and evaluation of CSP were determined based on the results of a literature search. Consensus was predefined as a level of agreement of at least 70% for each item, and a minimum of three Delphi rounds were planned (two online questionnaires and one group meeting).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Sixteen experts participated in the Delphi study and four Delphi rounds were performed. In total, 58 items were determined to be relevant. We differentiated between basic measurements to be performed in general practice and advanced measurements for expert centers or for research purposes. The panel also formulated advice on indications for referral to an expert clinic. Consensus was reached for all 58 items on the definition, terminology, relevant items for evaluation and reporting of CSP. It was recommended that the first CS scar evaluation to determine the location of the pregnancy should be performed at 6\u20137\u2009weeks' gestation using transvaginal ultrasound. The use of magnetic resonance imaging was not considered to add value in the diagnosis of CSP. A CSP was defined as a pregnancy with implantation in, or in close contact with, the niche. The experts agreed that a CSP can occur only when a niche is present and not in relation to a healed CS scar. Relevant sonographic items to record included gestational sac (GS) size, vascularity, location in relation to the uterine vessels, thickness of the residual myometrium and location of the pregnancy in relation to the uterine cavity and serosa. According to its location, a CSP can be classified as: (1) CSP in which the largest part of the GS protrudes towards the uterine cavity; (2) CSP in which the largest part of the GS is embedded in the myometrium but does not cross the serosal contour; and (3) CSP in which the GS is partially located beyond the outer contour of the cervix or uterus. The type of CSP may change with advancing gestation. Future studies are needed to validate this reporting system and the value of the different CSP types.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>\n                      Consensus was achieved among experts regarding the sonographic evaluation and reporting of CSP in the first trimester. \u00a9 2021 The Authors.\n                      <jats:italic>Ultrasound in Obstetrics &amp; Gynecology<\/jats:italic>\n                      published by John Wiley &amp; Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/uog.24815","type":"journal-article","created":{"date-parts":[[2021,11,15]],"date-time":"2021-11-15T00:40:43Z","timestamp":1636936843000},"page":"437-449","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":118,"title":["Definition and sonographic reporting system for Cesarean scar pregnancy in early gestation: modified Delphi method"],"prefix":"10.1002","volume":"59","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3875-7263","authenticated-orcid":false,"given":"I. P. M.","family":"Jordans","sequence":"first","affiliation":[{"name":"Department of Obstetrics and Gynecology, Research Institute \u201cAmsterdam Reproduction and Development\u201d, Amsterdam UMC location VU Medical Center  Amsterdam The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"C.","family":"Verberkt","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, Research Institute \u201cAmsterdam Reproduction and Development\u201d Amsterdam UMC, location AMC  Amsterdam The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"R. A.","family":"De Leeuw","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, Research Institute \u201cAmsterdam Reproduction and Development\u201d Amsterdam UMC, location AMC  Amsterdam The Netherlands"},{"name":"Department of Obstetrics and Gynecology Amsterdam UMC, location AMC  Amsterdam The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1894-0626","authenticated-orcid":false,"given":"C. M.","family":"Bilardo","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, Amsterdam UMC location VU Medical Center  Amsterdam The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6777-5036","authenticated-orcid":false,"given":"T.","family":"Van Den Bosch","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology University Hospitals KU Leuven  Leuven Belgium"},{"name":"Laboratory for Tumor Immunology and Immunotherapy KU Leuven  Leuven Belgium"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"T.","family":"Bourne","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology Imperial College London  London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"H. A. 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