{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,11]],"date-time":"2026-02-11T14:09:11Z","timestamp":1770818951861,"version":"3.50.1"},"reference-count":29,"publisher":"Georg Thieme Verlag KG","issue":"06","funder":[{"name":"CCL is supported by the UK National Institute for Health Research Biomedical Research Centre (BRC) based at Imperial College Healthcare National Health Service Trust and Imperial College"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Ultraschall Med"],"published-print":{"date-parts":[[2022,12]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:p>\n          Purpose\u2002To evaluate perioperative outcomes and the prognostic role of the tramline sign in a cohort of women with anterior placenta previa.<\/jats:p><jats:p>\n          Materials and Methods\u2002Retrospective analysis of 3D ultrasound volumes from women with anterior placenta previa who underwent ultrasound examination beyond 32 weeks. 3D and 3D color volumes were obtained from a sagittal section of the uterus bisecting a partially full bladder and processed using Crystal Vue and Crystal Vue Flow rendering to look for the \u201ctramline sign\u201d. \u201cPartial obliteration\u201d was defined as a loss of some or part of the uterine-serosal interface and \u201cfull obliteration\u201d as when both interfaces were interrupted. Postnatal ascertainment of placenta accreta spectrum (PAS) was confirmed by findings recorded intraoperatively or on a pathology report.<\/jats:p><jats:p>\n          Results\u200265 cases were included. The tramline sign was \u201cpartially\u201d (17) or \u201cfully\u201d (19) obliterated in 36 cases (55.4\u200a%), and present in 29 (44.6\u200a%). Obliteration was associated with earlier gestational age at delivery (35\u200a+\u200a1 (26\u200a+\u200a3\u201338\u200a+\u200a3) vs. 36\u200a+\u200a4 (25\u200a+\u200a3\u201338\u200a+\u200a0)  weeks, p\u200a=\u200a0.005), greater estimated blood loss (800 (400\u201311\u200a000) vs. 600 (300\u20132100) mls, p\u200a=\u200a0.003), longer operative time (155 (60\u2013240) vs. 54 (25\u201380) minutes, p\u200a&lt;\u200a0.001), higher rate of hysterectomy (97.2\u200a% vs. 0.0\u200a%, p\u200a&lt;\u200a0.001), longer postoperative admission (7 (3\u201319) vs. 3\u00a0(1\u20135) days, p\u200a&lt;\u200a0.001) and a 100\u200a% rate of postnatal diagnosis of PAS.\u200aThe finding of an \u201cobliterated\u201d tramline sign identified all women that required hysterectomy and all cases of PAS.<\/jats:p><jats:p>\n          Conclusion\u2002A \u201cpartially or fully obliterated\u201d tramline sign is strongly associated with indicators of operative complexity, the postnatal confirmation of PAS, and the need for peripartum hysterectomy.<\/jats:p>","DOI":"10.1055\/a-1309-1665","type":"journal-article","created":{"date-parts":[[2021,2,9]],"date-time":"2021-02-09T00:52:35Z","timestamp":1612831955000},"page":"e118-e124","source":"Crossref","is-referenced-by-count":13,"title":["Evaluation of the Tramline Sign in the Prediction of Placenta Accreta Spectrum and Perioperative Outcomes in Anterior Placenta Previa"],"prefix":"10.1055","volume":"43","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7201-0206","authenticated-orcid":false,"given":"Andrea","family":"Dall\u2019Asta","sequence":"additional","affiliation":[{"name":"Queen Charlottes and Chelsea Hospital, Imperial College Hleathcare NHS Trust, London, United Kingdom"},{"name":"Department of Metabolism, Digestion and Reproduction, Institute of Reproductive and Developmental Biology, Imperial College London, United Kingdom"},{"name":"Department of Medicine and Surgery, Obstetrics and Gynecology Unit, University of Parma, Parma, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Francesco","family":"Forlani","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynaecology, Arnas Civico Hospital, Palermo, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Harsha","family":"Shah","sequence":"additional","affiliation":[{"name":"Queen Charlottes and Chelsea Hospital, Imperial College Hleathcare NHS Trust, London, United Kingdom"},{"name":"Department of Metabolism, Digestion and Reproduction, Institute of Reproductive and Developmental Biology, Imperial College London, United Kingdom"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Gowrishankar","family":"Paramasivam","sequence":"additional","affiliation":[{"name":"Queen Charlottes and Chelsea Hospital, Imperial College Hleathcare NHS Trust, London, United Kingdom"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Joseph","family":"Yazbek","sequence":"additional","affiliation":[{"name":"Department of Gynaecologic Oncology, Queen Charlotte\u2019s and Chelsea Hospital, Imperial College Healthcare NHS Trust, London, United Kingdom"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tom","family":"Bourne","sequence":"additional","affiliation":[{"name":"Department of Metabolism, Digestion and Reproduction, Institute of Reproductive and Developmental Biology, Imperial College London, United Kingdom"},{"name":"Department of Development and Regeneration, KU\u00a0Leuven, Leuven, Belgium"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Giuseppe","family":"Cal\u00ec","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynaecology, Arnas Civico Hospital, Palermo, Italy"},{"name":"Department of Obstetrics and Gynaecology, Azienda Ospedaliera Villa Sofia Cervello, Palermo, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2104-5561","authenticated-orcid":false,"given":"Christoph","family":"Lees","sequence":"additional","affiliation":[{"name":"Queen Charlottes and Chelsea Hospital, Imperial College Hleathcare NHS Trust, London, United Kingdom"},{"name":"Department of Metabolism, Digestion and Reproduction, Institute of Reproductive and Developmental Biology, Imperial College London, United Kingdom"},{"name":"Department of Development and Regeneration, KU\u00a0Leuven, Leuven, Belgium"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"194","published-online":{"date-parts":[[2021,2,8]]},"reference":[{"key":"ref1","doi-asserted-by":"crossref","first-page":"429","DOI":"10.1016\/j.bpobgyn.2014.01.001","article-title":"Ultrasound in placental disorders","volume":"28","author":"F D\u2019Antonio","year":"2014","journal-title":"Best Pract Res Clin Obstet 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Ultrasound"],"original-title":[],"language":"de","link":[{"URL":"http:\/\/www.thieme-connect.de\/products\/ejournals\/pdf\/10.1055\/a-1309-1665.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,2,10]],"date-time":"2023-02-10T15:18:47Z","timestamp":1676042327000},"score":1,"resource":{"primary":{"URL":"http:\/\/www.thieme-connect.de\/DOI\/DOI?10.1055\/a-1309-1665"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,2,8]]},"references-count":29,"journal-issue":{"issue":"06","published-online":{"date-parts":[[2022,12,5]]},"published-print":{"date-parts":[[2022,12]]}},"URL":"https:\/\/doi.org\/10.1055\/a-1309-1665","archive":["Portico","CLOCKSS"],"relation":{},"ISSN":["0172-4614","1438-8782"],"issn-type":[{"value":"0172-4614","type":"print"},{"value":"1438-8782","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,2,8]]}}}