ACR appropriateness criteria® first trimester bleeding

Barton F. Lane, Jade J. Wong-You-Cheong, Marcia C. Javitt, Phyllis Glanc, Douglas L. Brown, Theodore Dubinsky, Mukesh G. Harisinghani, Robert D. Harris, Nadia J. Khati, Donald G. Mitchell, Pari V. Pandharipande, Harpreet K. Pannu, Anne E. Podrasky, Thomas D. Shipp, Cary Lynn Siegel, Lynn Simpson, Darci J. Wall, Carolyn M. Zelop

Research output: Contribution to journalArticle

11 Citations (Scopus)

Abstract

Vaginal bleeding is not uncommon in the first trimester of pregnancy. Ultrasound is the foremost modality for evaluating normal development of the gestational sac and embryo and for discriminating the causes of bleeding. While correlation with quantitative βHCG and clinical presentation is essential, sonographic criteria permit diagnosis of failed pregnancies, ectopic pregnancy, gestational trophoblastic disease and spontaneous abortion. The American College of Radiology Appropriateness Criteria guidelines have been updated to incorporate recent data. A failed pregnancy may be diagnosed when there is absence of cardiac activity in an embryo exceeding 7 mm in crown rump length or absence of an embryo when the mean sac diameter exceeds 25 mm. In a stable patient with no intrauterine pregnancy and normal adnexae, close monitoring is advised. The diagnosis of ectopic pregnancy should be based on positive findings rather than on the absence of an intrauterine sac above a threshold level of βHCG. Following abortion, ultrasound can discriminate retained products of conception from clot and arteriovenous fistulae. The American College of Radiology Appropriateness Criteria® are evidence-based guidelines for specific clinical conditions that are reviewed every two years by a multidisciplinary expert panel. The guideline development and review include an extensive analysis of current medical literature from peer reviewed journals and the application of a well-established consensus methodology (modified Delphi) to rate the appropriateness of imaging and treatment procedures by the panel. In those instances where evidence is lacking or not definitive, expert opinion may be used to recommend imaging or treatment.

Original languageEnglish (US)
Pages (from-to)91-96
Number of pages6
JournalUltrasound Quarterly
Volume29
Issue number2
DOIs
StatePublished - Jun 2013

Fingerprint

First Pregnancy Trimester
Embryonic Structures
Ectopic Pregnancy
Guidelines
Hemorrhage
Radiology
Pregnancy
Gestational Sac
Gestational Trophoblastic Disease
Crown-Rump Length
Uterine Hemorrhage
Arteriovenous Fistula
Expert Testimony
Spontaneous Abortion
Therapeutics

Keywords

  • Appropriateness Criteria
  • early pregnancy
  • ectopic pregnancy
  • first trimester bleeding
  • threatened abortion
  • vaginal bleeding

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging

Cite this

Lane, B. F., Wong-You-Cheong, J. J., Javitt, M. C., Glanc, P., Brown, D. L., Dubinsky, T., ... Zelop, C. M. (2013). ACR appropriateness criteria® first trimester bleeding. Ultrasound Quarterly, 29(2), 91-96. https://doi.org/10.1097/RUQ.0b013e31829158c2

ACR appropriateness criteria® first trimester bleeding. / Lane, Barton F.; Wong-You-Cheong, Jade J.; Javitt, Marcia C.; Glanc, Phyllis; Brown, Douglas L.; Dubinsky, Theodore; Harisinghani, Mukesh G.; Harris, Robert D.; Khati, Nadia J.; Mitchell, Donald G.; Pandharipande, Pari V.; Pannu, Harpreet K.; Podrasky, Anne E.; Shipp, Thomas D.; Siegel, Cary Lynn; Simpson, Lynn; Wall, Darci J.; Zelop, Carolyn M.

In: Ultrasound Quarterly, Vol. 29, No. 2, 06.2013, p. 91-96.

Research output: Contribution to journalArticle

Lane, BF, Wong-You-Cheong, JJ, Javitt, MC, Glanc, P, Brown, DL, Dubinsky, T, Harisinghani, MG, Harris, RD, Khati, NJ, Mitchell, DG, Pandharipande, PV, Pannu, HK, Podrasky, AE, Shipp, TD, Siegel, CL, Simpson, L, Wall, DJ & Zelop, CM 2013, 'ACR appropriateness criteria® first trimester bleeding', Ultrasound Quarterly, vol. 29, no. 2, pp. 91-96. https://doi.org/10.1097/RUQ.0b013e31829158c2
Lane BF, Wong-You-Cheong JJ, Javitt MC, Glanc P, Brown DL, Dubinsky T et al. ACR appropriateness criteria® first trimester bleeding. Ultrasound Quarterly. 2013 Jun;29(2):91-96. https://doi.org/10.1097/RUQ.0b013e31829158c2
Lane, Barton F. ; Wong-You-Cheong, Jade J. ; Javitt, Marcia C. ; Glanc, Phyllis ; Brown, Douglas L. ; Dubinsky, Theodore ; Harisinghani, Mukesh G. ; Harris, Robert D. ; Khati, Nadia J. ; Mitchell, Donald G. ; Pandharipande, Pari V. ; Pannu, Harpreet K. ; Podrasky, Anne E. ; Shipp, Thomas D. ; Siegel, Cary Lynn ; Simpson, Lynn ; Wall, Darci J. ; Zelop, Carolyn M. / ACR appropriateness criteria® first trimester bleeding. In: Ultrasound Quarterly. 2013 ; Vol. 29, No. 2. pp. 91-96.
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