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Definition and sonographic reporting system for Cesarean scar pregnancy in early gestation : modified Delphi method

Jordans, I. P.M. ; Verberkt, C. ; De Leeuw, R. A. ; Bilardo, C. M. ; Van Den Bosch, T. ; Bourne, T. ; Brölmann, H. A.M. ; Dueholm, M. ; Hehenkamp, W. J.K. and Jastrow, N. , et al. (2022) In Ultrasound in Obstetrics and Gynecology 59(4). p.437-449
Abstract

Objective: To develop a standardized sonographic evaluation and reporting system for Cesarean scar pregnancy (CSP) in the first trimester, for use by both general gynecology and expert clinics. Methods: A modified Delphi procedure was carried out, in which 28 international experts in obstetric and gynecological ultrasonography were invited to participate. Extensive experience in the use of ultrasound to evaluate Cesarean section (CS) scars in early pregnancy and/or publications concerning CSP or niche evaluation was required to participate. Relevant items for the detection and evaluation of CSP were determined based on the results of a literature search. Consensus was predefined as a level of agreement of at least 70% for each item, and... (More)

Objective: To develop a standardized sonographic evaluation and reporting system for Cesarean scar pregnancy (CSP) in the first trimester, for use by both general gynecology and expert clinics. Methods: A modified Delphi procedure was carried out, in which 28 international experts in obstetric and gynecological ultrasonography were invited to participate. Extensive experience in the use of ultrasound to evaluate Cesarean section (CS) scars in early pregnancy and/or publications concerning CSP or niche evaluation was required to participate. Relevant items for the detection and evaluation of CSP were determined based on the results of a literature search. Consensus was predefined as a level of agreement of at least 70% for each item, and a minimum of three Delphi rounds were planned (two online questionnaires and one group meeting). Results: Sixteen experts participated in the Delphi study and four Delphi rounds were performed. In total, 58 items were determined to be relevant. We differentiated between basic measurements to be performed in general practice and advanced measurements for expert centers or for research purposes. The panel also formulated advice on indications for referral to an expert clinic. Consensus was reached for all 58 items on the definition, terminology, relevant items for evaluation and reporting of CSP. It was recommended that the first CS scar evaluation to determine the location of the pregnancy should be performed at 6–7 weeks' gestation using transvaginal ultrasound. The use of magnetic resonance imaging was not considered to add value in the diagnosis of CSP. A CSP was defined as a pregnancy with implantation in, or in close contact with, the niche. The experts agreed that a CSP can occur only when a niche is present and not in relation to a healed CS scar. Relevant sonographic items to record included gestational sac (GS) size, vascularity, location in relation to the uterine vessels, thickness of the residual myometrium and location of the pregnancy in relation to the uterine cavity and serosa. According to its location, a CSP can be classified as: (1) CSP in which the largest part of the GS protrudes towards the uterine cavity; (2) CSP in which the largest part of the GS is embedded in the myometrium but does not cross the serosal contour; and (3) CSP in which the GS is partially located beyond the outer contour of the cervix or uterus. The type of CSP may change with advancing gestation. Future studies are needed to validate this reporting system and the value of the different CSP types. Conclusion: Consensus was achieved among experts regarding the sonographic evaluation and reporting of CSP in the first trimester.

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type
Contribution to journal
publication status
published
subject
keywords
Cesarean scar pregnancy, cicatrix, classification, Delphi technique, pregnancy, ultrasonography
in
Ultrasound in Obstetrics and Gynecology
volume
59
issue
4
pages
13 pages
publisher
John Wiley & Sons Inc.
external identifiers
  • pmid:34779085
  • scopus:85127441767
ISSN
0960-7692
DOI
10.1002/uog.24815
language
English
LU publication?
yes
id
016de5a0-14e6-41c5-a654-65ccd4879db2
date added to LUP
2022-06-07 15:11:04
date last changed
2024-06-13 09:33:55
@article{016de5a0-14e6-41c5-a654-65ccd4879db2,
  abstract     = {{<p>Objective: To develop a standardized sonographic evaluation and reporting system for Cesarean scar pregnancy (CSP) in the first trimester, for use by both general gynecology and expert clinics. Methods: A modified Delphi procedure was carried out, in which 28 international experts in obstetric and gynecological ultrasonography were invited to participate. Extensive experience in the use of ultrasound to evaluate Cesarean section (CS) scars in early pregnancy and/or publications concerning CSP or niche evaluation was required to participate. Relevant items for the detection and evaluation of CSP were determined based on the results of a literature search. Consensus was predefined as a level of agreement of at least 70% for each item, and a minimum of three Delphi rounds were planned (two online questionnaires and one group meeting). Results: Sixteen experts participated in the Delphi study and four Delphi rounds were performed. In total, 58 items were determined to be relevant. We differentiated between basic measurements to be performed in general practice and advanced measurements for expert centers or for research purposes. The panel also formulated advice on indications for referral to an expert clinic. Consensus was reached for all 58 items on the definition, terminology, relevant items for evaluation and reporting of CSP. It was recommended that the first CS scar evaluation to determine the location of the pregnancy should be performed at 6–7 weeks' gestation using transvaginal ultrasound. The use of magnetic resonance imaging was not considered to add value in the diagnosis of CSP. A CSP was defined as a pregnancy with implantation in, or in close contact with, the niche. The experts agreed that a CSP can occur only when a niche is present and not in relation to a healed CS scar. Relevant sonographic items to record included gestational sac (GS) size, vascularity, location in relation to the uterine vessels, thickness of the residual myometrium and location of the pregnancy in relation to the uterine cavity and serosa. According to its location, a CSP can be classified as: (1) CSP in which the largest part of the GS protrudes towards the uterine cavity; (2) CSP in which the largest part of the GS is embedded in the myometrium but does not cross the serosal contour; and (3) CSP in which the GS is partially located beyond the outer contour of the cervix or uterus. The type of CSP may change with advancing gestation. Future studies are needed to validate this reporting system and the value of the different CSP types. Conclusion: Consensus was achieved among experts regarding the sonographic evaluation and reporting of CSP in the first trimester.</p>}},
  author       = {{Jordans, I. P.M. and Verberkt, C. and De Leeuw, R. A. and Bilardo, C. M. and Van Den Bosch, T. and Bourne, T. and Brölmann, H. A.M. and Dueholm, M. and Hehenkamp, W. J.K. and Jastrow, N. and Jurkovic, D. and Kaelin Agten, A. and Mashiach, R. and Naji, O. and Pajkrt, E. and Timmerman, D. and Vikhareva, O. and Van Der Voet, L. F. and Huirne, J. A.F.}},
  issn         = {{0960-7692}},
  keywords     = {{Cesarean scar pregnancy; cicatrix; classification; Delphi technique; pregnancy; ultrasonography}},
  language     = {{eng}},
  number       = {{4}},
  pages        = {{437--449}},
  publisher    = {{John Wiley & Sons Inc.}},
  series       = {{Ultrasound in Obstetrics and Gynecology}},
  title        = {{Definition and sonographic reporting system for Cesarean scar pregnancy in early gestation : modified Delphi method}},
  url          = {{http://dx.doi.org/10.1002/uog.24815}},
  doi          = {{10.1002/uog.24815}},
  volume       = {{59}},
  year         = {{2022}},
}