{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,18]],"date-time":"2026-10-18T03:29:33Z","timestamp":1792294173470,"version":"4.4.0"},"reference-count":20,"publisher":"Wiley","issue":"4","license":[{"start":{"date-parts":[[2024,2,26]],"date-time":"2024-02-26T00:00:00Z","timestamp":1708905600000},"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;amp; Gyne"],"published-print":{"date-parts":[[2024,4]]},"abstract":"<jats:title>ABSTRACT<\/jats:title><jats:sec><jats:title>Objective<\/jats:title><jats:p>To examine the value of the crossover sign (COS) in predicting treatment outcome in women with a Cesarean scar pregnancy (CSP) who were treated with ultrasound\u2010guided vacuum aspiration.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>This was a retrospective cohort study of women with CSP who underwent ultrasound\u2010guided vacuum aspiration. Based on the relationship between the gestational sac, Cesarean scar and anterior wall of the uterus, CSPs were classified by COS type. Analysis was conducted to investigate the association between COS type (COS\u20101, COS\u20102) and treatment outcome. The incidence of treatment failure, retained pregnancy tissue, secondary therapy and bleeding \u2265\u2009200\u2009mL were analyzed.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>In total, 181 eligible patients with CSP, including 90 (49.7%) women with COS\u20101 and 91 (50.3%) women with COS\u20102, were analyzed. COS\u20101 patients had a higher incidence of treatment failure compared with COS\u20102 patients (25.6% <jats:italic>vs<\/jats:italic> 8.8%; <jats:italic>P<\/jats:italic>\u2009=\u20090.003), as well as higher rates of retained pregnancy tissue (18.9% <jats:italic>vs<\/jats:italic> 6.6%; <jats:italic>P<\/jats:italic>\u2009=\u20090.013), secondary therapy (20.0% <jats:italic>vs<\/jats:italic> 6.6%; <jats:italic>P<\/jats:italic>\u2009=\u20090.002) and bleeding of \u2265\u2009200\u2009mL (13.3% <jats:italic>vs<\/jats:italic> 4.4%; <jats:italic>P<\/jats:italic>\u2009=\u20090.034). COS\u20101 and a large gestational sac (30.1\u201350.0\u2009mm or &gt;50.0\u2009mm in diameter) were associated independently with increased risk of treatment failure (odds ratio, 4.57 (95%\u2009CI, 1.66\u201312.56); <jats:italic>P<\/jats:italic>\u2009=\u20090.003, 4.34 (95%\u2009CI, 1.35\u201313.94); <jats:italic>P<\/jats:italic>\u2009=\u20090.014 and 10.50 (95%\u2009CI, 2.54\u201343.46); <jats:italic>P<\/jats:italic>\u2009=\u20090.001, respectively).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Ultrasound evaluation of the relationship between the gestational sac and the endometrial line (COS classification) in women with CSP may help to predict treatment outcome among those undergoing vacuum aspiration. Among COS\u20101 patients, especially those with a gestational sac diameter of &gt;30.0\u2009mm, vacuum aspiration may be discouraged. \u00a9 2023 International Society of Ultrasound in Obstetrics and Gynecology.<\/jats:p><\/jats:sec>","DOI":"10.1002\/uog.27459","type":"journal-article","created":{"date-parts":[[2023,8,23]],"date-time":"2023-08-23T15:09:46Z","timestamp":1692803386000},"page":"544-550","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Predictive value of crossover sign for outcome of ultrasound\u2010guided vacuum aspiration in women with Cesarean scar pregnancy"],"prefix":"10.1002","volume":"63","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2057-2255","authenticated-orcid":false,"given":"M.","family":"Shen","sequence":"first","affiliation":[{"name":"Department of Gynecology Shengli Clinical Medical College of Fujian Medical University, Fujian Provincial Hospital  Fuzhou Fujian Province China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"L.","family":"Li","sequence":"additional","affiliation":[{"name":"Department of Ultrasound Shengli Clinical Medical College of Fujian Medical University, Fujian Provincial Hospital  Fuzhou Fujian Province China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"L.","family":"Zhu","sequence":"additional","affiliation":[{"name":"Department of Ultrasound Shengli Clinical Medical College of Fujian Medical University, Fujian Provincial Hospital  Fuzhou Fujian Province China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"J.","family":"Liu","sequence":"additional","affiliation":[{"name":"Department of Gynecology Shengli Clinical Medical College of Fujian Medical University, Fujian Provincial Hospital  Fuzhou Fujian Province China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2028-5475","authenticated-orcid":false,"given":"T.","family":"Lin","sequence":"additional","affiliation":[{"name":"Department of Gynecology Shengli Clinical Medical College of Fujian Medical University, Fujian Provincial Hospital  Fuzhou Fujian Province China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"X.","family":"Liu","sequence":"additional","affiliation":[{"name":"Department of Gynecology Shengli Clinical Medical College of Fujian Medical University, Fujian Provincial Hospital  Fuzhou Fujian Province China"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2024,2,26]]},"reference":[{"key":"e_1_2_8_2_1","doi-asserted-by":"publisher","DOI":"10.1002\/uog.24815"},{"key":"e_1_2_8_3_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajog.2020.01.030"},{"key":"e_1_2_8_4_1","doi-asserted-by":"publisher","DOI":"10.1002\/uog.17568"},{"key":"e_1_2_8_5_1","doi-asserted-by":"publisher","DOI":"10.1046\/j.1469-0705.2000.00300-2.x"},{"key":"e_1_2_8_6_1","doi-asserted-by":"publisher","DOI":"10.1002\/uog.16216"},{"issue":"44","key":"e_1_2_8_7_1","first-page":"e1","article-title":"The diagnosis, treatment, and follow\u2010up of cesarean scar pregnancy","volume":"207","author":"Timor\u2010Tritsch IE","year":"2012","journal-title":"Am J Obstet Gynecol"},{"key":"e_1_2_8_8_1","doi-asserted-by":"publisher","DOI":"10.1002\/uog.15857"},{"key":"e_1_2_8_9_1","doi-asserted-by":"publisher","DOI":"10.1002\/uog.17440"},{"key":"e_1_2_8_10_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajog.2017.01.019"},{"key":"e_1_2_8_11_1","doi-asserted-by":"publisher","DOI":"10.3389\/fphar.2020.601977"},{"key":"e_1_2_8_12_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.fertnstert.2022.04.029"},{"key":"e_1_2_8_13_1","doi-asserted-by":"publisher","DOI":"10.3389\/fphar.2022.822319"},{"key":"e_1_2_8_14_1","doi-asserted-by":"publisher","DOI":"10.1002\/uog.13282"},{"key":"e_1_2_8_15_1","doi-asserted-by":"publisher","DOI":"10.1002\/uog.13426"},{"key":"e_1_2_8_16_1","doi-asserted-by":"publisher","DOI":"10.1111\/jog.14319"},{"key":"e_1_2_8_17_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jmig.2016.01.012"},{"key":"e_1_2_8_18_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ejogrb.2015.06.023"},{"key":"e_1_2_8_19_1","doi-asserted-by":"publisher","DOI":"10.1002\/ijgo.12881"},{"key":"e_1_2_8_20_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00404-020-05877-9"},{"key":"e_1_2_8_21_1","doi-asserted-by":"publisher","DOI":"10.2147\/TCRM.S139682"}],"container-title":["Ultrasound in Obstetrics &amp; 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