{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,27]],"date-time":"2026-08-27T01:59:20Z","timestamp":1787795960452,"version":"build-2784847793"},"reference-count":36,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2024,12,15]],"date-time":"2024-12-15T00:00:00Z","timestamp":1734220800000},"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; Gyne"],"published-print":{"date-parts":[[2025,1]]},"abstract":"<jats:title>ABSTRACT<\/jats:title><jats:sec><jats:title>Objective<\/jats:title><jats:p>Accurate differentiation between placenta accreta spectrum (PAS) and uterine\u2010scar dehiscence with underlying non\u2010adherent placenta is often challenging, even for PAS experts, both prenatally and intraoperatively. We investigated the use of standardized two\u2010dimensional grayscale ultrasound and Doppler imaging markers in differentiating between these closely related, yet distinct, conditions.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>This was a retrospective cohort study conducted in two centers with specialized PAS services. All consecutive women with at least one previous Cesarean delivery and a current pregnancy with a low\u2010lying placenta or placenta previa, for whom detailed prenatal ultrasound, management and outcome information was available for review by the research team, were included. PAS was diagnosed clinically by the abnormal adherence of the placenta to the uterus. The PAS cases were classified using the International Federation of Gynecology and Obstetrics clinical classification. Grade\u20091 was considered low\u2010grade PAS while Grades\u20092 and 3 were classified as high\u2010grade PAS. The ultrasound markers were categorized according to their underlying pathophysiology, including lower uterine segment (LUS) remodeling, uteroplacental vascular remodeling and serosal hypervascularity. The combined ultrasound features were analyzed among the PAS and non\u2010PAS subgroups using the chi\u2010square test or Fisher's exact test, and univariable and multivariable logistic regression analysis. Additionally, receiver\u2010operating\u2010characteristics (ROC) curves were used  to evaluate the diagnostic  accuracy  of the combined ultrasound features in differentiating between high\u2010grade PAS and uterine\u2010scar dehiscence.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Out of the 150 cases retrieved, six cases were excluded for not meeting the eligibility criteria. The included 144 cases comprised 89 cases of PAS, 23 cases of uterine\u2010scar dehiscence and 32 cases of uncomplicated low\u2010lying placenta or placenta previa. Among the PAS cases, there were 16 cases of low\u2010grade PAS and 73  of high\u2010grade PAS. Combined signs of LUS remodeling were present in most cases of uterine\u2010scar dehiscence (20\/23 (87.0%)) and high\u2010grade PAS (67\/73 (91.8%)) (<jats:italic>P<\/jats:italic>\u2009=\u20090.444), while these signs were absent in cases of low\u2010grade PAS (0\/16) and uncomplicated low\u2010lying placenta or placenta previa (0\/32). A subgroup analysis of cases with all LUS remodeling features present revealed that the combined signs of serosal hypervascularity (adjusted odds ratio (aOR), 41.2 (95%\u2009CI, 7.5\u2013225.3)) and uteroplacental vascular remodeling (aOR, 116.0 (95%\u2009CI, 15.3\u2013878.3)) were significantly associated with high\u2010grade PAS. Diagnostic accuracy testing within this subgroup revealed an area under the ROC curve (AUC) of 0.90 (95%\u2009CI, 0.81\u20130.99), sensitivity of 89.6% (95%\u2009CI, 79.7\u201395.7%) and specificity of 90.0% (95%\u2009CI, 68.3\u201398.8%) for the diagnosis of high\u2010grade PAS when all signs of uteroplacental vascular remodeling were present. If both signs of serosal hypervascularity were present, the AUC was 0.84 (95%\u2009CI, 0.74\u20130.95) with a sensitivity of 83.6% (95%\u2009CI, 72.5\u201391.5%) and specificity of 85.0% (95%\u2009CI, 62.1\u201396.8%) for the diagnosis of high\u2010grade PAS.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>The combined ultrasound markers of LUS remodeling are common in both high\u2010grade PAS and uterine\u2010scar dehiscence, while the combined features of abnormal vascularity (uteroplacental vascular remodeling and serosal hypervascularity) are specific to high\u2010grade PAS. Understanding these pathophysiological differences would enhance the diagnostic accuracy of ultrasound in distinguishing between these two conditions. \u00a9 2024 The Author(s). <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.29144","type":"journal-article","created":{"date-parts":[[2024,12,15]],"date-time":"2024-12-15T23:34:02Z","timestamp":1734305642000},"page":"85-93","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":11,"title":["Exploring pathophysiological insights to improve diagnostic utility of ultrasound markers for distinguishing placenta accreta spectrum from uterine\u2010scar dehiscence"],"prefix":"10.1002","volume":"65","author":[{"given":"T.","family":"Adu\u2010Bredu","sequence":"first","affiliation":[{"name":"Nuffield Department of Women's and Reproductive Health University of Oxford  Oxford UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6674-7682","authenticated-orcid":false,"given":"R. A.","family":"Aryananda","sequence":"additional","affiliation":[{"name":"Anatomical Pathology Department, Dr Soetomo Academic General Hospital Universitas Airlangga  Surabaya Indonesia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"S.","family":"Mathewlynn","sequence":"additional","affiliation":[{"name":"Nuffield Department of Women's and Reproductive Health University of Oxford  Oxford UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"S. L.","family":"Collins","sequence":"additional","affiliation":[{"name":"Nuffield Department of Women's and Reproductive Health University of Oxford  Oxford UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2024,12,15]]},"reference":[{"key":"e_1_2_6_2_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajog.2019.02.054"},{"key":"e_1_2_6_3_1","doi-asserted-by":"publisher","DOI":"10.1002\/uog.13194"},{"key":"e_1_2_6_4_1","doi-asserted-by":"publisher","DOI":"10.1111\/1471-0528.17286"},{"key":"e_1_2_6_5_1","doi-asserted-by":"publisher","DOI":"10.1136\/bcr-2021-244286"},{"key":"e_1_2_6_6_1","doi-asserted-by":"publisher","DOI":"10.1097\/AOG.0000000000003793"},{"key":"e_1_2_6_7_1","doi-asserted-by":"publisher","DOI":"10.1097\/AOG.0000000000005075"},{"key":"e_1_2_6_8_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.placenta.2008.04.008"},{"key":"e_1_2_6_9_1","doi-asserted-by":"publisher","DOI":"10.1111\/1471-0528.17496"},{"key":"e_1_2_6_10_1","doi-asserted-by":"publisher","DOI":"10.1055\/s-0043-1770917"},{"key":"e_1_2_6_11_1","doi-asserted-by":"publisher","DOI":"10.3389\/frph.2023.1068377"},{"key":"e_1_2_6_12_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajogmf.2024.101333"},{"issue":"2","key":"e_1_2_6_13_1","first-page":"114","article-title":"Invasion anomaly or neovascularization? 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