ACR Appropriateness Criteria® First Trimester Bleeding

被引:16
作者
Lane, Barton F. [1 ]
Wong-You-Cheong, Jade J. [1 ]
Javitt, Marcia C. [2 ]
Glanc, Phyllis [3 ]
Brown, Douglas L. [4 ]
Dubinsky, Theodore [5 ]
Harisinghani, Mukesh G. [6 ]
Harris, Robert D. [7 ]
Khati, Nadia J. [8 ]
Mitchell, Donald G. [9 ]
Pandharipande, Pari V. [6 ]
Pannu, Harpreet K. [10 ]
Podrasky, Anne E. [11 ]
Shipp, Thomas D. [12 ]
Siegel, Cary Lynn [13 ]
Simpson, Lynn [14 ]
Wall, Darci J. [4 ]
Zelop, Carolyn M. [15 ]
机构
[1] Univ Maryland, Sch Med, Baltimore, MD 21201 USA
[2] Walter Reed Natl Mil Med Ctr, Bethesda, MD USA
[3] Sunnybrook Hlth Sci Ctr, Toronto, ON M4N 3M5, Canada
[4] Mayo Clin, Rochester, MN USA
[5] Univ Washington, Sch Med, Seattle, WA USA
[6] Massachusetts Gen Hosp, Boston, MA 02114 USA
[7] Dartmouth Hitchcock Med Ctr, Lebanon, NH 03766 USA
[8] George Washington Univ Hosp, Washington, DC USA
[9] Thomas Jefferson Univ Hosp, Philadelphia, PA 19107 USA
[10] Mem Sloan Kettering Canc Ctr, New York, NY 10021 USA
[11] Baptist Hosp Miami, South Miami Ctr Women & Infants, Miami, FL USA
[12] Brigham & Womens Hosp, Boston, MA 02115 USA
[13] Washington Univ, Med Ctr, Mallinckrodt Inst Radiol, St Louis, MO 63110 USA
[14] Columbia Univ, New York, NY USA
[15] Valley Hosp, Ridgewood, NJ USA
关键词
Appropriateness Criteria; vaginal bleeding; early pregnancy; ectopic pregnancy; threatened abortion; first trimester bleeding; GESTATIONAL TROPHOBLASTIC DISEASE; EMBRYONIC HEART-RATE; EARLY INTRAUTERINE PREGNANCY; ECTOPIC PREGNANCY; INTRADECIDUAL SIGN; 1ST-TRIMESTER PREGNANCIES; SAC DIAMETER; TUBAL RING; DIAGNOSIS; US;
D O I
10.1097/RUQ.0b013e31829158c2
中图分类号
R8 [特种医学]; R445 [影像诊断学];
学科分类号
1002 ; 100207 ; 1009 ;
摘要
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 beta HCG 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 beta HCG. Following abortion, ultrasound can discriminate retained products of conception from clot and arteriovenous fistulae. The American College of Radiology Appropriateness Criteria (R) 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.
引用
收藏
页码:91 / 96
页数:6
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