Ushakov F, et al. - Researchers sought to define a new first-trimester sonographic sign, the ‘crash sign’, connected with fetal open spina bifida. Further, they examined its clinical utility in the first-trimester diagnosis of spina bifida. Patients referred to three fetal medicine centers in the first trimester (11 + 0 to 13 + 6 weeks) with suspected spina bifida were asked to undergo ultrasound for direct visualization of the spinal defect to confirm spina bifida by two experts and, when possible, by fetal postmortem examination. The crash sign is the posterior displacement of the mesencephalon and deformation against the occipital bone in the axial view. Forty-eight out of 53 confirmed cases of spina bifida exhibited the crash sign. Outcomes suggest the possible utility of the crash sign as a tool in the first-trimester detection of spina bifida. In a routine clinical screening ultrasound setting, evaluation of the crash sign appeared to be beneficial.