{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,6]],"date-time":"2026-10-06T19:54:50Z","timestamp":1791316490579,"version":"4.3.1"},"reference-count":79,"publisher":"Wiley","issue":"4","license":[{"start":{"date-parts":[[2026,7,23]],"date-time":"2026-07-23T00:00:00Z","timestamp":1784764800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2026,7,23]],"date-time":"2026-07-23T00:00:00Z","timestamp":1784764800000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"funder":[{"DOI":"10.13039\/501100012166","name":"National Key Research and Development Program of China","doi-asserted-by":"publisher","award":["2022YFC2704503"],"award-info":[{"award-number":["2022YFC2704503"]}],"id":[{"id":"10.13039\/501100012166","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["obgyn.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Ultrasound in Obstet &amp;amp; Gyne"],"published-print":{"date-parts":[[2026,10]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>To review systematically and assess quantitatively the incidence and risk of placenta accreta spectrum (PAS) disorders and hysterectomy in Cesarean scar pregnancy (CSP) continuing into mid\u2010to\u2010late gestation.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      A comprehensive literature search was performed in PubMed, EMBASE, Cochrane Library,\n                      <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" xlink:href=\"http:\/\/clinicaltrials.gov\">ClinicalTrials.gov<\/jats:ext-link>\n                      , China National Knowledge Infrastructure (CNKI) and Yiigle databases from inception to 12 February 2025. Studies reporting the rates of PAS and\/or hysterectomy in women with a singleton CSP that continued \u2265\u200914\u2009weeks' gestation were eligible for inclusion. Data extracted included information on medical history, CSP classification and clinical manifestation, gestational age at delivery and pregnancy outcome. Data were synthesized as pooled incidences and odds ratios with 95%\u2009CIs, and random\u2010effects models were used owing to high heterogeneity. Subgroup analyses were performed according to CSP subtype (Type\u2009I\n                      <jats:italic>vs<\/jats:italic>\n                      Type\u2009II\n                      <jats:italic>vs<\/jats:italic>\n                      Type\u2009III; and endogenous\n                      <jats:italic>vs<\/jats:italic>\n                      exogenous) and residual myometrial thickness (RMT) (\u2264\u20093\u2009mm\n                      <jats:italic>vs<\/jats:italic>\n                      &gt;\u20093\u2009mm).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Among 61 studies included in the systematic review, 20 studies (432 cases) were eligible for inclusion in the meta\u2010analysis. Qualitative synthesis captured severe clinical phenotypes, including spontaneous uterine rupture and massive hemorrhage during Cesarean section. The pooled incidences of PAS and hysterectomy were 0.90 (95%\u2009CI, 0.81\u20130.96) and 0.39 (95%\u2009CI, 0.22\u20130.57), respectively. Marked heterogeneity was observed across CSP subtypes: Type\u2010III and exogenous CSPs were associated with significantly higher odds of invasive PAS, hysterectomy and preterm delivery compared with Types\u2010I\/II and endogenous subtypes, respectively. Reduced RMT was associated significantly with increased odds of overall PAS and invasive PAS, and was predictive of hysterectomy on receiver\u2010operating\u2010characteristics\u2010curve analysis. The pooled incidence of reaching \u2265 28 weeks\u2019 gestation was 0.85 (95%\u2009CI, 0.73\u20130.94), whereas the pooled incidence of reaching term (\u2265\u200937\u2009weeks)\u00a0was 0.19 (95%\u2009CI, 0.10\u20130.30). Among studies that reported uterine rupture, the pooled incidence of this outcome was 0.05 (95%\u2009CI, 0.02\u20130.10).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Type\u2010III and exogenous CSPs that progress into mid\u2010to\u2010late gestation present substantial risks for PAS and hysterectomy, with a low likelihood of term delivery. Type\u2010I, Type\u2010II and endogenous CSPs are associated with a comparatively lower risk of adverse outcome. CSP subtype and RMT are key determinants for risk stratification and individualized counseling. \u00a9 2026 International Society of Ultrasound in Obstetrics and Gynecology.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/uog.70293","type":"journal-article","created":{"date-parts":[[2026,7,23]],"date-time":"2026-07-23T07:38:46Z","timestamp":1784792326000},"page":"468-479","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Adverse outcome in Cesarean scar pregnancy continuing into mid\u2010to\u2010late gestation: systematic review and meta\u2010analysis"],"prefix":"10.1002","volume":"68","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1242-4938","authenticated-orcid":false,"given":"S.","family":"Zeng","sequence":"first","affiliation":[{"name":"Department of Obstetrics and Gynecology Peking University Third Hospital  Beijing China"},{"name":"National Clinical Research Center for Obstetrics and Gynecology 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