Early first‐trimester transvaginal ultrasound is indicated in pregnancy after previous Cesarean delivery: should it be mandatory?

Timor‐Tritsch, Ilan E.; D’Antonio, F.; Calì, Giuseppe; Palacios‐Jaraquemada, José Miguel; Meyer, Jessica A.; Monteagudo, Ana

doi:10.1002/uog.20225

Cited by 39 publications

(29 citation statements)

References 61 publications

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“…In view of the recently reported association between CSP and PAS disorders, we have recently suggested that women with a prior CD or uterine surgery should undergo early sonographic assessment in order to detect CSP. It is the collective opinion of the authors that an accurate clinical and sonographic evaluation of a pregnancy after a previous CD can facilitate not only timely counseling, but also, if needed, gestational‐age‐appropriate individualized pregnancy management. However, the effect of such a screening program on the costs for national health services should be balanced against its efficacy in improving the outcome of these women, as it may pose an ethical dilemma especially when CSP is detected in asymptomatic women.…”

Section: Discussionmentioning

confidence: 99%

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Value of first‐trimester ultrasound in prediction of third‐trimester sonographic stage of placenta accreta spectrum disorder and surgical outcome

Calì

Timor‐Tritsch

Forlani

et al. 2020

Ultrasound in Obstet & Gyne

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Objectives To explore whether early first‐trimester ultrasound can predict the third‐trimester sonographic stage of placenta accreta spectrum (PAS) disorder and to elucidate whether combining first‐trimester ultrasound findings with the sonographic stage of PAS disorder can stratify the risk of adverse surgical outcome in women at risk for PAS disorder. Methods This was a retrospective analysis of prospectively collected data from women with placenta previa, and at least one previous Cesarean delivery (CD) or uterine surgery, for whom early first‐trimester (5–7 weeks' gestation) ultrasound images could be retrieved. The relationship between the position of the gestational sac and the prior CD scar was assessed using three sonographic markers for first‐trimester assessment of Cesarean scar (CS) pregnancy, reported by Calí et al. (crossover sign (COS)), Kaelin Agten et al. (implantation of the gestational sac on the scar vs in the niche of the CS) and Timor‐Tritsch et al. (position of the center of the gestational sac below vs above the midline of the uterus), by two different examiners blinded to the final diagnosis and clinical outcome. The primary aim of the study was to explore the association between first‐trimester ultrasound findings and the stage of PAS disorder on third‐trimester ultrasound. Our secondary aim was to elucidate whether the combination of first‐trimester ultrasound findings and sonographic stage of PAS disorder can predict surgical outcome. Logistic regression analysis and area under the receiver‐operating‐characteristics curve (AUC) were used to analyze the data. Results One hundred and eighty‐seven women with vasa previa were included. In this cohort, 79.6% (95% CI, 67.1–88.2%) of women classified as COS‐1, 94.4% (95% CI, 84.9–98.1%) of those with gestational‐sac implantation in the niche of the prior CS and 100% (95% CI, 93.4–100%) of those with gestational sac located below the uterine midline, on first‐trimester ultrasound, were affected by the severest form of PAS disorder (PAS3) on third‐trimester ultrasound. On multivariate logistic regression analysis, COS‐1 (odds ratio (OR), 7.9 (95% CI, 4.0–15.5); P < 0.001), implantation of the gestational sac in the niche (OR, 29.1 (95% CI, 8.1–104); P < 0.001) and location of the gestational sac below the midline of the uterus (OR, 38.1 (95% CI, 12.0–121); P < 0.001) were associated independently with PAS3, whereas parity (P = 0.4) and the number of prior CDs (P = 0.5) were not. When translating these figures into diagnostic models, first‐trimester diagnosis of COS‐1 (AUC, 0.94 (95% CI, 0.91–0.97)), pregnancy implantation in the niche (AUC, 0.92 (95% CI, 0.89–0.96)) and gestational sac below the uterine midline (AUC, 0.92 (95% CI, 0.88–0.96)) had a high predictive accuracy for PAS3. There was an adverse surgical outcome in 22/187 pregnancies and it was more common in women with, compared to those without, COS‐1 (P < 0.001), gestational‐sac implantation in the niche (P < 0.001) and gestational‐sac position below the uterine midline (P <...

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Section: Discussionmentioning

confidence: 99%

“…It has been shown recently that early first‐trimester (5–7 weeks' gestation) ultrasound assessment can predict the possibility of developing PAS disorder in women at high risk for this anomaly, thus supporting the role of early sonographic evaluation as a potential early predictor of this complication.…”

Section: Introductionmentioning

confidence: 87%

Value of first‐trimester ultrasound in prediction of third‐trimester sonographic stage of placenta accreta spectrum disorder and surgical outcome

Calì

Timor‐Tritsch

Forlani

et al. 2020

Ultrasound in Obstet & Gyne

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“…24,40,41 Therefore, every patient who had at least a single previous CD should be assessed for signs of an abnormally adherent placenta starting early in the first trimester of pregnancy. 24,42 Cesarean scar pregnancy, as a precursor of PAS, can be diagnosed as early as 5 to 8 weeks' gestation by a low position of the gestational sac near a cesarean scar, and specific US signs of PAS can be visualized starting at 11 to 14 weeks in specialized centers. Risk stratification based on the obstetric history and US findings in the first trimester might improve the perinatal outcome and reduce maternal morbidity and mortality.…”

Section: Discussionmentioning

confidence: 99%

Diagnosis and Management of Cesarean Scar Pregnancy and Placenta Accreta Spectrum

Panaitescu

Ciobanu

Gică

et al. 2020

J of Ultrasound Medicine

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With an increased cesarean delivery rate, the incidence of abnormal placentation is steadily rising, and it is estimated to be around 1.7 per 1000 pregnancies for cesarean scar pregnancy and 1 per 500 pregnancies for placenta accreta spectrum disorder. Current evidence considers cesarean scar pregnancy and placenta accreta spectrum as being the same condition, with different aspects, of the same spectrum, having higher risks with advancing gestation. We present 7 cases, diagnosed and managed in our hospital, at different gestational ages. Early diagnosis is essential for appropriate counseling and subsequent management, and an ultrasound examination is the reference standard for diagnosis. Screening for an abnormally implanted placenta in the first trimester of pregnancy might improve the perinatal outcome and reduce maternal morbidity and mortality.

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“…Approximately half of the CSP patients had no obvious early symptoms, based on these reports and our results we strongly recommended to pay more attention to patients after cesarean section, especially when they experience vaginal bleeding. Timor-Tritsch et al [21] have suggested that routine ultrasound screening for CSP should be performed in pregnant women with a history of cesarean section at gestational weeks 5-7 like screening for aneuploidy and preeclampsia. Early detection of CSP is critical to prevent its progression and improve the long-term prognoses.…”

Section: Discussionmentioning

confidence: 99%

Clinical characteristics and treatment of different types of cesarean scar pregnancy

Yin

Shihai

2020

Ginekol Pol

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Objectives: The purpose of this study was to evaluate the clinical characteristics and compare the treatment efficacy of different types of cesarean scar pregnancy (CSP). Material and methods: We performed a retrospective chart review of 66 women (69 cases) with CSP who received treatment with mifepristone/methotrexate (MTX) plus curettage, uterine artery embolization (UAE) plus curettage, additional MTX, or laparotomy, and compared the clinical characteristics, treatment efficacy, and occurrence of complications among 3 types of CSP (partial, complete, and mass type). Results: Review of the 69 cases revealed a considerable increase of gestational duration(p < 0.001), sac/lesion size(p < 0.001) and vaginal bleeding (p < 0.05) in patients with mass-type CSP compared to that of other types. All CSP cases were successfully treated, 4 cases of mass-type received laparotomy and none of the cases required a hysterectomy. Severe bleeding was observed in 2 cases of partial-type and complete-type, respectively, and 3 cases for mass-type. Moreover, bleeding occurred during initial treatment with mifepristone plus curettage in partial-type cases, but not with UAE plus curettage. Conclusions: UAE plus curettage is a more effective treatment option for partial-and complete-type of CSP than mifepristone plus curettage. The cases of mass-type often need surgery and are prone to have longer gestational duration, larger lesions, and more vaginal bleeding.

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Early first‐trimester transvaginal ultrasound is indicated in pregnancy after previous Cesarean delivery: should it be mandatory?

Cited by 39 publications

References 61 publications

Value of first‐trimester ultrasound in prediction of third‐trimester sonographic stage of placenta accreta spectrum disorder and surgical outcome

Value of first‐trimester ultrasound in prediction of third‐trimester sonographic stage of placenta accreta spectrum disorder and surgical outcome

Diagnosis and Management of Cesarean Scar Pregnancy and Placenta Accreta Spectrum

Clinical characteristics and treatment of different types of cesarean scar pregnancy

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