As the number of Cesarean deliveries has increased, so has the incidence of abnormal invasion of the placenta (AIP). It is now commonly believed that Cesarean scar pregnancy (CSP) and AIP represent the same histopathological entity presenting at different gestational ages. This Virtual Issue brings together a series of original research articles, systematic reviews and editorial pieces which highlight the use of prenatal imaging in detecting CSP and AIP, as well as the role that early diagnosis can play in reducing the morbidity associated with these conditions.
Please see below a summary of the content in the March Virtual Issue of the Journal. This Virtual Issue contains free-access content. To view all UOG content, become an ISUOG member today or login and upgrade.
Terminology of AIP
The nomenclature used in the treatment, diagnosis and research of AIP is varied, making comparisons across studies and improvement in care of affected women difficult. Editorials in this Virtual Issue aimed to address this matter; Collins et al. proposed standardized definitions based on analysis of 23 studies included in a systematic review of the antenatal sonographic diagnosis of AIP, and Alfiveric et al. proposed standardized means of reporting ultrasound assessment of suspected AIP in an international expert consensus. A more recent Editorial from Bhide et al. advises that standardization based on robust data is still required.
Prenatal detection of AIP
Prenatal detection of AIP has been shown to reduce maternal and fetal morbidity associated with the condition. A Systematic Review by D’Antonio et al. assessed the performance of ultrasound in at-risk women for prenatal identification of AIP, finding it to have high accuracy in such women. A subsequent Systematic Review from this group investigated the performance of prenatal magnetic resonance imaging (MRI) in diagnosing AIP and found it to have high accuracy, comparable to that of ultrasound. Further research from D’Antonio et al. provided systematic review of studies on first-trimester detection of AIP on ultrasound, finding that its markers may be present even at this early stage of gestation.
Treatment and management of CSP and AIP
Early treatment of CSP can prevent serious maternal morbidity associated with advanced CSP. An Original Article by Jurkovic et al. found ultrasound-guided suction curettage to be an effective method. Surgical treatment is, however, associated with complications such as severe bleeding. Timor-Tritsch et al. investigated placement and inflation of Foley balloon catheters prophylactically to prevent or control such bleeding, and found it to be an effective method. An Original Article by Calì et al. investigated the cross-over sign (a marker for CSP proposed in an earlier article by Calì et al. included in this issue) as a predictor of surgical outcome in AIP, and found that it may identify those who are at higher risk of intra- or postsurgical morbidity.
This Virtual Issue also contains articles on alternative approaches to traditional surgery. A more conservative surgical approach, the Triple-P method, was investigated in an Original Article by Teixidor Viñas et al., and was found to improve maternal outcome. A Systematic Review by Calì et al. assessed studies on women diagnosed with CSP managed expectantly, finding it to be a reasonable option in CSP with no cardiac activity.