Natural history of Cesarean scar pregnancy on prenatal ultrasound: the crossover sign
Natural history of Cesarean scar pregnancy on prenatal ultrasound: the crossover sign
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DOI：
10.1002/uog.16216
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发表时间：
2017-07-01
影响因子：
7.1
通讯作者：
D'Antonio, F.
中科院分区：
文献类型：
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作者：
Cali, G.;Forlani, F.;D'Antonio, F.
目的产前影像学检查技术的进步提高了剖宫产瘢痕妊娠（CSP）的诊断率。然而，诊断CSP时的产前咨询是具有挑战性的，目前的证据主要来自小系列报告的不良孕产妇结局的高发生率。本研究的目的是确定产前超声预测CSP的自然史使用一个新的超声标志，交叉标志（COS）的性能。方法这是一个回顾性分析早期妊娠（6-8周的妊娠）的超声图像在妇女与病态粘连胎盘（MAP）管理在妊娠晚期。分析CSP妊娠囊、子宫前壁和剖宫产瘢痕（定义为COS）之间的关系，以确定其是否可以预测这些病例的进展。结果68例妊娠合并MAP患者中，COS-1、COS-2+、COS-2-与MAP的发生率无明显相关性，而COS-1、COS-2+、COS-2-与MAP的发生率无明显相关性。COS-1妊娠的胎盘植入风险显著高于COS-2妊娠（OR，6.67（95%CI，1.3-33.3））。当分别评估COS-2的两种变体时，COS-1妊娠的胎盘穿透风险显著高于COS-2+妊娠（OR，5.83（95% CI，1.1-30.2）），当比较COS-1与COS-2-妊娠时，该风险甚至更高（OR，12.0（95% CI，1.9-75.7））。Logistic回归分析显示，COS-1与重度MAP（如胎盘植入和胎盘植入）独立相关。（OR，12.85（95%CI，2.0-84.0）），而COS-2+与胎盘植入独立相关（OR，4.37（95%CI，结论超声评价CSP孕囊与子宫内膜线（COS）的关系可能有助于确定CSP是否会进展为不太严重的MAP形式，是否适合产后治疗，以及是否有成功的妊娠结局。需要进行大型前瞻性研究来证实我们的发现并阐明这种疾病的自然史。版权所有（C）2016 ISUOG.出版社：John Wiley & Sons Ltd
Objective Advances in prenatal imaging techniques have led to an increase in the diagnosis of Cesarean scar pregnancy (CSP). However, antenatal counseling when CSP is diagnosed is challenging, and current evidence is derived mainly from small series reporting high rates of adverse maternal outcomes. The aim of this study was to ascertain the performance of prenatal ultrasound in predicting the natural history of CSP using a new sonographic sign, the crossover sign (COS).Methods This was a retrospective analysis of early first-trimester (6-8 weeks' gestation) ultrasound images in women with morbidly adherent placenta (MAP) managed in the third trimester of pregnancy. The relationship between the gestational sac of the CSP, anterior uterine wall and Cesarean scar, defined as the COS, was analyzed to determine whether it could predict evolution in these cases. Odds ratios (ORs) were calculated and logistic regression analysis was performed to investigate the association between different types of COS (COS-1, COS-2+ or COS-2-) and the occurrence of MAP.Results Sixty-eight pregnancies with MAP were included. The risk of placenta percreta was significantly higher in pregnancies with COS-1 than in those with COS-2 (OR, 6.67 (95% CI, 1.3-33.3)). When evaluating the two variants of COS-2 separately, the risk of placenta percreta was significantly higher in pregnancies with COS-1 vs COS-2+ (OR, 5.83 (95% CI, 1.1-30.2)) and this risk was even higher when comparing cases with COS-1 vs COS-2- (OR, 12.0 (95% CI, 1.9-75.7)). Logistic regression analysis showed that COS-1 was associated independently with severe forms of MAP, such as placenta percreta and increta (OR, 12.85 (95% CI, 2.0-84.0)), while COS-2+ was associated independently with placenta accreta (OR, 4.37 (95% CI, 1.1-17.0)).Conclusions Ultrasound assessment of the relationship between the gestational sac of a CSP and the endometrial line (the COS) may help to determine whether a CSP will progress towards a less severe form of MAP, amenable to postnatal treatment, and successful pregnancy outcome. Large prospective studies are needed to confirm our findings and elucidate the natural history of this condition. Copyright (C) 2016 ISUOG. Published by John Wiley & Sons Ltd.