Cesarean scar pregnancy and early placenta accreta share common histology
Open accessAbstract
Objective: To determine, by evaluation of histological slides, images and descriptions of early (second‐trimester) placenta accreta ( EPA ) and placental implantation in cases of Cesarean scar pregnancy ( CSP ), whether these are pathologically indistinguishable and whether they both represent different stages in the disease continuum leading to morbidly adherent placenta in the third trimester . Methods: The database of a previously published review of CSP and EPA was used to identify articles with histopathological descriptions and electronic images for pathological review. When possible, microscopic slides and/or paraffin blocks were obtained from the original researchers. We also included from our own institutions cases of CSP and EPA for which pathology specimens were available. Two pathologists examined all the material independently and, blinded to each other's findings, provided a pathological diagnosis based on microscopic appearance. Interobserver agreement in diagnosis was determined . Results: Forty articles were identified, which included 31 cases of CSP and 13 cases of EPA containing histopathological descriptions and/or images of the pathology. We additionally included six cases of CSP and eight cases of EPA from our own institutions, giving a total of 58 cases available for histological evaluation (37 CSP and 21 EPA ) containing clear definitions of morbidly adherent placenta. In the 29 cases for which images/slides were available for histopathological evaluation, both pathologists attested to the various degrees of myometrial and/or scar tissue invasion by placental villi with scant or no intervening decidua, consistent with the classic definition of morbidly adherent placenta. Based on the reviewed material, cases with a diagnosis of EPA and those with a diagnosis of CSP showed identical histopathological features. Interobserver correlation was high (kappa = 0.93) . Conclusions: EPA and placental implantation in CSP are histopathologically indistinguishable and may represent different stages in the disease continuum leading to morbidly adherent placenta in the third trimester. Copyright © 2013 ISUOG. Published by John Wiley & Sons Ltd .
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There has been an increase in reports describing implantation into deficient caesarean section scars and mounting evidence that a caesarean scar pregnancy diagnosed in early pregnancy can evolve into an abnormally adherent or invasive placenta in the second half of pregnancy.
“More recently, there has been an increase in reports describing implantation into deficient caesarean section scars and mounting evidence that a caesarean scar pregnancy diagnosed in early pregnancy can evolve into an abnormally adherent or invasive placenta in the second half of pregnancy.126-130”
From Placenta Praevia and Placenta Accreta: Diagnosis and Management: Green‐top Guideline No. 27a (2019) · cites this paper as [128]
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- Authors
- Timor‐Tritsch, I. E., Monteagudo, A., Cali, G., Palacios‐Jaraquemada, J. M., Maymon, R., Arslan, A. A., Patil, N., Popiolek, D., & Mittal, K. R.
- Affiliations
- New York University (US)
- Department of Obstetrics and Gynecology Arnas Civico Hospital Palermo Italy
- Centre for Medical Education and Clinical Research (CEMIC) University Hospital Buenos Aires Argentina
- Tel Aviv University (IL)
- Mount Sinai Hospital (US)
- Corresponding author
- Timor‐Tritsch, I. E.
- Venue
- Ultrasound in Obstetrics & Gynecology
- Publisher
- Wiley
- Published
- 2014-04
- Volume
- 43
- Issue
- 4
- Pages
- 383-395
- ISSN
- 0960-7692 (ISSN-L)
- 1469-0705
- OpenAlex
- W1924482072
- Cited by
- 267
- References
- 75
- Citations by year
- 2026: 22 · 2025: 17 · 2024: 17 · 2023: 30 · 2022: 26 · 2021: 24 · 2020: 32 · 2019: 11 · 2018: 25 · 2017: 35 · 2016: 12 · 2015: 13 · 2014: 2
- FWCI
- 1.27
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Ultrasound in Obstetrics and Gynecology (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Pediatrics, Perinatology and Child Health › Maternal and fetal healthcare
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Ectopic Pregnancy Diagnosis and Management
- Health Sciences › Medicine › Obstetrics and Gynecology › Pregnancy and preeclampsia studies
- Keywords
- cesarean scar pregnancy, placenta accreta spectrum, placental implantation, histopathology, myometrial invasion, disease continuum, interobserver agreement
- MeSH terms
- Cesarean Section, Cicatrix, Female, Humans, Placenta, Placenta Accreta, Pregnancy, Pregnancy Trimester, Second, Pregnancy Trimester, Third, Pregnancy, Ectopic, Ultrasonography, Early Diagnosis
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
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