{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,23]],"date-time":"2026-07-23T18:53:41Z","timestamp":1784832821524,"version":"3.55.0"},"reference-count":20,"publisher":"Georg Thieme Verlag KG","issue":"S 01","license":[{"start":{"date-parts":[[2023,2,21]],"date-time":"2023-02-21T00:00:00Z","timestamp":1676937600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Am J Perinatol"],"published-print":{"date-parts":[[2024,5]]},"abstract":"<jats:p>\n            Objective\u2003The nomenclature has evolved from low implantation to cesarean scar pregnancy (CSP) and criteria are recommended for identification and management. Management guidelines include pregnancy termination due to life-threatening complications. This article applies ultrasound (US) parameters recommended by the Society for Maternal Fetal Medicine (SMFM) in women who were expectantly managed.<\/jats:p><jats:p>\n            Study Design\u2003Pregnancies were identified between March 1, 2013 and December 31, 2020. Inclusion criteria were women with CSP or low implantation identified on US. Studies were reviewed for niche, smallest myometrial thickness (SMT), and location of basalis blinded to clinical data. Clinical outcomes, pregnancy outcome, need for intervention, hysterectomy, transfusion, pathologic findings, and morbidities were obtained by chart review.<\/jats:p><jats:p>\n            Results Of 101 pregnancies with low implantation, 43 met the SMFM criteria at\u2009&lt;\u200910 weeks and 28 at 10 to 14 weeks. At\u2009&lt;\u200910 weeks, SMFM criteria identified 45out of 76 women; of these 13 required hysterectomy; there were 6 who required hysterectomy but did not meet the SMFM criteria. At 10 to\u2009&lt;\u200914 weeks, SMFM criteria identified 28 out of 42 women; of these 15 required hysterectomy. US parameters yielded significant differences in women requiring hysterectomy, at\u2009&lt;\u200910 weeks and 10 to\u2009&lt;\u200914 weeks' gestational age epochs, but the sensitivity, specificity, positive (PPV), and negative predictive values (NPV) of these US parameters have limitations in identifying invasion to determine management. Of the 101 pregnancies, 46 (46%) failed\u2009&lt;\u200920 weeks, 16 (35%) required medical\/surgical management including 6 hysterectomies, and 30 (65%) required no intervention. There were 55 pregnancies (55%) that progressed beyond 20 weeks. Of these, 16 required hysterectomy (29%) while 39 (71%) did not. In the overall cohort of 101, 22 (21.8%) required hysterectomy and an additional16 (15.8%) required some type of intervention, while 66.7% required no intervention.<\/jats:p><jats:p>\n            Conclusion\u2003SMFM US criteria for CSP have limitations for discerning clinical management due to lack of discriminatory threshold.<\/jats:p><jats:p>\n            Key Points\n          <\/jats:p>","DOI":"10.1055\/a-2040-1458","type":"journal-article","created":{"date-parts":[[2023,2,21]],"date-time":"2023-02-21T23:54:00Z","timestamp":1677023640000},"page":"e1445-e1450","source":"Crossref","is-referenced-by-count":10,"special_numbering":"S","title":["The Cesarean Scar of Pregnancy: Ultrasound Findings and Expectant Management Outcomes"],"prefix":"10.1055","volume":"41","author":[{"given":"Catherine Y.","family":"Spong","sequence":"additional","affiliation":[{"name":"Departments of Obstetrics and Gynecology, University of Texas Southwestern Medical Center, Dallas, Texas"},{"name":"Parkland Health, Dallas, Texas"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Casey S.","family":"Yule","sequence":"additional","affiliation":[{"name":"Departments of Obstetrics and Gynecology, University of Texas Southwestern Medical Center, Dallas, Texas"},{"name":"Parkland Health, Dallas, Texas"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elaine T.","family":"Fleming","sequence":"additional","affiliation":[{"name":"Departments of Obstetrics and Gynecology, University of Texas Southwestern Medical Center, Dallas, Texas"},{"name":"Parkland Health, Dallas, Texas"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9634-9076","authenticated-orcid":false,"given":"Ashlyn K.","family":"Lafferty","sequence":"additional","affiliation":[{"name":"Departments of Obstetrics and Gynecology, University of Texas Southwestern Medical Center, Dallas, Texas"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Donald D.","family":"McIntire","sequence":"additional","affiliation":[{"name":"Departments of Obstetrics and Gynecology, University of Texas Southwestern Medical Center, Dallas, Texas"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Diane M.","family":"Twickler","sequence":"additional","affiliation":[{"name":"Departments of Obstetrics and Gynecology, University of Texas Southwestern Medical Center, Dallas, Texas"},{"name":"Departments of Radiology, University of Texas Southwestern Medical Center, Dallas, Texas"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"194","published-online":{"date-parts":[[2023,3,31]]},"reference":[{"issue":"05","key":"ref1","doi-asserted-by":"crossref","first-page":"B2","DOI":"10.1016\/j.ajog.2020.01.030","article-title":"Society for Maternal-Fetal Medicine (SMFM) Consult Series #49: cesarean scar pregnancy","volume":"222","author":"R Miller","year":"2020","journal-title":"Am J Obstet Gynecol"},{"issue":"07","key":"ref2","doi-asserted-by":"crossref","first-page":"2589","DOI":"10.1007\/s00261-015-0472-2","article-title":"Cesarean scar ectopic pregnancy: imaging features, current treatment options, and clinical outcomes","volume":"40","author":"R M Riaz","year":"2015","journal-title":"Abdom Imaging"},{"issue":"06","key":"ref3","doi-asserted-by":"crossref","first-page":"1373","DOI":"10.1097\/01.AOG.0000218690.24494.ce","article-title":"Cesarean scar ectopic pregnancies: etiology, diagnosis, and management","volume":"107","author":"M A Rotas","year":"2006","journal-title":"Obstet Gynecol"},{"issue":"02","key":"ref4","doi-asserted-by":"crossref","first-page":"278","DOI":"10.1093\/humrep\/deh060","article-title":"Ectopic pregnancies in Caesarean section scars: the 8 year experience of one medical centre","volume":"19","author":"R Maymon","year":"2004","journal-title":"Hum 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A review","volume":"207","author":"I E Timor-Tritsch","year":"2012","journal-title":"Am J Obstet Gynecol"},{"issue":"02","key":"ref9","doi-asserted-by":"crossref","first-page":"263","DOI":"10.7863\/ultra.15.03020","article-title":"Sonographic findings of morbidly adherent placenta in the first trimester","volume":"35","author":"M WF Rac","year":"2016","journal-title":"J Ultrasound Med"},{"issue":"03","key":"ref10","doi-asserted-by":"crossref","first-page":"475","DOI":"10.7863\/ultra.33.3.475","article-title":"Biometric sonographic findings of abnormally adherent trophoblastic implantations on cesarean delivery scars","volume":"33","author":"E Moschos","year":"2014","journal-title":"J Ultrasound Med"},{"issue":"10","key":"ref11","doi-asserted-by":"crossref","first-page":"1907","DOI":"10.1002\/jum.15295","article-title":"Prospective first-trimester ultrasound of low implantation and placenta accreta spectrum","volume":"39","author":"S K Happe","year":"2020","journal-title":"J Ultrasound Med"},{"issue":"13","key":"ref12","doi-asserted-by":"crossref","first-page":"1663","DOI":"10.1111\/1471-0528.15255","article-title":"Caesarean scar pregnancy in the UK: a national cohort study","volume":"125","author":"H M Harb","year":"2018","journal-title":"BJOG"},{"issue":"04","key":"ref13","doi-asserted-by":"crossref","first-page":"601","DOI":"10.7863\/ultra.34.4.601","article-title":"Cesarean scar pregnancies: experience of 60 cases","volume":"34","author":"I E Timor-Tritsch","year":"2015","journal-title":"J Ultrasound Med"},{"issue":"04","key":"ref14","doi-asserted-by":"crossref","first-page":"365","DOI":"10.1515\/jpm-2017-0189","article-title":"Expectant management of caesarean scar ectopic pregnancy: a systematic review","volume":"46","author":"P Jayaram","year":"2018","journal-title":"J Perinat Med"},{"issue":"03","key":"ref15","doi-asserted-by":"crossref","first-page":"367","DOI":"10.1002\/uog.14775","article-title":"Natural history of early first-trimester pregnancies implanted in Cesarean scars","volume":"46","author":"N Zosmer","year":"2015","journal-title":"Ultrasound Obstet Gynecol"},{"issue":"04","key":"ref16","doi-asserted-by":"crossref","first-page":"383","DOI":"10.1002\/uog.13282","article-title":"Cesarean scar pregnancy and early placenta accreta share common histology","volume":"43","author":"I E Timor-Tritsch","year":"2014","journal-title":"Ultrasound Obstet Gynecol"},{"issue":"03","key":"ref17","doi-asserted-by":"crossref","first-page":"346","DOI":"10.1002\/uog.13426","article-title":"Cesarean scar pregnancy is a precursor of morbidly adherent placenta","volume":"44","author":"I E Timor-Tritsch","year":"2014","journal-title":"Ultrasound Obstet Gynecol"},{"issue":"12","key":"ref18","doi-asserted-by":"crossref","first-page":"1167","DOI":"10.1111\/j.0001-6349.2004.00445.x","article-title":"Subsequent pregnancy outcome after conservative treatment of a previous cesarean scar pregnancy","volume":"83","author":"K M Seow","year":"2004","journal-title":"Acta Obstet Gynecol Scand"},{"issue":"04","key":"ref19","doi-asserted-by":"crossref","first-page":"958","DOI":"10.1016\/j.fertnstert.2015.12.130","article-title":"Cesarean scar pregnancy: a systematic review of treatment studies","volume":"105","author":"K Birch Petersen","year":"2016","journal-title":"Fertil Steril"},{"issue":"12","key":"ref20","doi-asserted-by":"crossref","first-page":"2735","DOI":"10.1002\/jum.15674","article-title":"Transvaginal color mapping ultrasound in the first trimester predicts placenta accreta spectrum: a retrospective cohort study","volume":"40","author":"C S Yule","year":"2021","journal-title":"J Ultrasound Med"}],"container-title":["American Journal of Perinatology"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/www.thieme-connect.de\/products\/ejournals\/pdf\/10.1055\/a-2040-1458.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,11,5]],"date-time":"2024-11-05T13:25:44Z","timestamp":1730813144000},"score":1,"resource":{"primary":{"URL":"http:\/\/www.thieme-connect.de\/DOI\/DOI?10.1055\/a-2040-1458"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,2,21]]},"references-count":20,"journal-issue":{"issue":"S 01","published-online":{"date-parts":[[2024,5,13]]},"published-print":{"date-parts":[[2024,5]]}},"URL":"https:\/\/doi.org\/10.1055\/a-2040-1458","archive":["Portico","CLOCKSS"],"relation":{},"ISSN":["0735-1631","1098-8785"],"issn-type":[{"value":"0735-1631","type":"print"},{"value":"1098-8785","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2023,2,21]]},"published":{"date-parts":[[2023,2,21]]}}}