{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,4]],"date-time":"2026-09-04T15:43:40Z","timestamp":1788536620433,"version":"build-2803163510"},"reference-count":17,"publisher":"Wiley","issue":"3","license":[{"start":{"date-parts":[[2022,9,1]],"date-time":"2022-09-01T00:00:00Z","timestamp":1661990400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/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":[[2022,9]]},"abstract":"<jats:title>ABSTRACT<\/jats:title><jats:sec><jats:title>Objective<\/jats:title><jats:p>To evaluate the  performance of third\u2010trimester ultrasound for the diagnosis of clinically significant placenta accreta spectrum disorder (PAS) in women with low\u2010lying placenta or placenta previa.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>This was a prospective multicenter study of pregnant women aged \u2265\u200918\u2009years who were diagnosed with low\u2010lying placenta (&lt;\u200920\u2009mm from the internal cervical os) or placenta previa (covering the internal cervical os) on ultrasound at \u2265\u200926\u2009+\u20090\u2009weeks' gestation, between October 2014 and January 2019. Ultrasound suspicion of PAS was raised in the presence of at least one of these signs on grayscale ultrasound: (1) obliteration of the hypoechogenic space between the uterus and the placenta; (2) interruption of the hyperechogenic interface between the uterine serosa and the bladder wall; (3) abnormal placental lacunae. Histopathological examinations were performed according to a predefined protocol, with pathologists blinded to the ultrasound findings. To assess the ability of ultrasound to detect clinically significant PAS, a composite outcome comprising the need for active management at delivery and histopathological confirmation of PAS was considered the reference standard. PAS was considered to be clinically significant if, in addition to histological confirmation, at least one of these procedures was carried out after delivery: use of hemostatic intrauterine balloon, compressive uterine suture, peripartum hysterectomy, uterine\/hypogastric artery ligation or uterine artery embolization. The diagnostic performance of each ultrasound sign for clinically significant PAS was evaluated in all women and in the subgroup who had at least one previous Cesarean section and anterior placenta. Post\u2010test probability was assessed using Fagan nomograms.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>A total of 568 women underwent transabdominal and transvaginal ultrasound examinations during the study period. Of these, 95 delivered in local hospitals, and placental pathology according to the study protocol was therefore not available. Among the 473 women for whom placental pathology was available, clinically significant PAS was diagnosed in 99 (21%), comprising 36 cases of placenta accreta, 19 of placenta increta and 44 of placenta percreta. The median gestational age at the time of ultrasound assessment was 31.4 (interquartile range, 28.6\u201334.4) weeks. A normal hypoechogenic space between the uterus and the placenta reduced the post\u2010test probability of clinically significant PAS from 21% to 5% in women with low\u2010lying placenta or placenta previa in the third trimester of pregnancy and from 62% to 9% in the subgroup with previous Cesarean section and anterior placenta. The absence of placental lacunae reduced the post\u2010test probability of clinically significant PAS from 21% to 9% in women with low\u2010lying placenta or placenta previa in the third trimester of pregnancy and from 62% to 36% in the subgroup with previous Cesarean section and anterior placenta. When abnormal placental lacunae were seen on ultrasound, the post\u2010test probability of clinically significant PAS increased from 21% to 59% in the whole cohort and from 62% to 78% in the subgroup with previous Cesarean section and anterior placenta. An interrupted hyperechogenic interface between the uterine serosa and bladder wall increased the post\u2010test probability for clinically significant PAS from 21% to 85% in women with low\u2010lying placenta or placenta previa and from 62% to 88% in the subgroup with previous Cesarean section and anterior placenta. When all three sonographic markers were present, the post\u2010test probability for clinically significant PAS increased from 21% to 89% in the whole cohort and from 62% to 92% in the subgroup with previous Cesarean section and anterior placenta.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Grayscale ultrasound has good diagnostic performance to identify pregnancies at low risk of PAS in a high\u2010risk population of women with low\u2010lying placenta or placenta previa. Ultrasound may be safely used to guide management decisions and concentrate resources on patients with higher risk of clinically significant PAS. \u00a9 2022 The Authors. <jats:italic>Ultrasound in Obstetrics &amp; Gynecology<\/jats:italic> published by John Wiley &amp; Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.<\/jats:p><\/jats:sec>","DOI":"10.1002\/uog.24889","type":"journal-article","created":{"date-parts":[[2022,3,5]],"date-time":"2022-03-05T17:23:09Z","timestamp":1646500989000},"page":"381-389","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":40,"title":["Third\u2010trimester ultrasound for antenatal diagnosis of placenta accreta spectrum in women with placenta previa: results from the <scp>ADoPAD<\/scp> study"],"prefix":"10.1002","volume":"60","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-0417-1793","authenticated-orcid":false,"given":"N.","family":"Fratelli","sequence":"first","affiliation":[{"name":"Division of Obstetrics and Gynecology, ASST Spedali Civili, Department of Clinical and Experimental Sciences University of Brescia  Brescia Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7793-714X","authenticated-orcid":false,"given":"F.","family":"Prefumo","sequence":"additional","affiliation":[{"name":"Division of Obstetrics and Gynecology, ASST Spedali Civili, Department of Clinical and Experimental Sciences University of Brescia  Brescia Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3537-6131","authenticated-orcid":false,"given":"C.","family":"Maggi","sequence":"additional","affiliation":[{"name":"Division of Obstetrics and Gynecology, ASST Spedali Civili, Department of Clinical and Experimental Sciences University of Brescia  Brescia Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"C.","family":"Cavalli","sequence":"additional","affiliation":[{"name":"Division of Obstetrics and Gynecology, ASST Spedali Civili, Department of Clinical and Experimental Sciences University of Brescia  Brescia Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"A.","family":"Sciarrone","sequence":"additional","affiliation":[{"name":"Obstetrics\u2013Gynecological Ultrasound and Prenatal Diagnosis Unit, Department of Obstetrics and Gynecology Citt\u00e0 della Salute e della Scienza  Turin Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6914-9805","authenticated-orcid":false,"given":"A.","family":"Garofalo","sequence":"additional","affiliation":[{"name":"Obstetrics\u2013Gynecological Ultrasound and Prenatal Diagnosis Unit, Department of Obstetrics and Gynecology Citt\u00e0 della Salute e della Scienza  Turin Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7981-8363","authenticated-orcid":false,"given":"E.","family":"Viora","sequence":"additional","affiliation":[{"name":"Obstetrics\u2013Gynecological Ultrasound and Prenatal Diagnosis Unit, Department of Obstetrics and Gynecology Citt\u00e0 della Salute e della Scienza  Turin Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5028-0045","authenticated-orcid":false,"given":"P.","family":"Vergani","sequence":"additional","affiliation":[{"name":"University of Milan\u2010Bicocca, School of Medicine and Surgery, Department of Obstetrics and Gynecology Fondazione MBBM Onlus, San Gerardo Hospital  Monza Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6898-7217","authenticated-orcid":false,"given":"S.","family":"Ornaghi","sequence":"additional","affiliation":[{"name":"University of Milan\u2010Bicocca, School of Medicine and Surgery, Department of Obstetrics and Gynecology Fondazione MBBM Onlus, San Gerardo Hospital  Monza Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6447-1221","authenticated-orcid":false,"given":"M.","family":"Betti","sequence":"additional","affiliation":[{"name":"Obstetrics and Gynaecology Unit, A. 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