ACR Appropriateness Criteria® Second and Third Trimester Bleeding
ACR Appropriateness Criteria® Second and Third Trimester Bleeding
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DOI：
10.1097/ruq.0000000000000044
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发表时间：
2013-12-01
影响因子：
1.3
通讯作者：
Zelop, Carolyn M.
中科院分区：
文献类型：
--
作者：
Podrasky, Ann E.;Javitt, Marcia C.;Zelop, Carolyn M.
发生在妊娠第二或第三个三个月的阴道出血可能会影响围产期结局，这取决于它是轻微的（即单次，轻度发作）还是严重的（严重出血或多次发作）。超声用于评估这些患者。超声检查的结果可以从边缘绒毛膜下血肿到胎盘水肿。前置胎盘、植入性胎盘、前置血管等异常胎盘需要准确的诊断才能为临床治疗提供依据。在胎盘植入的情况下，磁共振成像是有用的，作为一个辅助超声，往往是适当的评估胎盘浸润的程度和邻近结构的潜在参与。MRI是有用的预先计划的情况下，复杂的交付，这可能需要一个多学科的方法，以获得最佳的care.The美国放射学会适当的标准是基于证据的指导方针，为特定的临床条件，每两年由一个多学科的专家小组进行审查。指南的制定和审查包括对来自同行评审期刊的当前医学文献进行广泛分析，并应用成熟的共识方法（改良德尔菲法）对专家组的成像和治疗程序的适当性进行评级。在缺乏证据或证据不明确的情况下，专家意见可用于推荐成像或治疗。
Vaginal bleeding occurring in the second or third trimesters of pregnancy can variably affect perinatal outcome, depending on whether it is minor (i.e. a single, mild episode) or major (heavy bleeding or multiple episodes.) Ultrasound is used to evaluate these patients. Sonographic findings may range from marginal subchorionic hematoma to placental abruption. Abnormal placentations such as placenta previa, placenta accreta and vasa previa require accurate diagnosis for clinical management. In cases of placenta accreta, magnetic resonance imaging is useful as an adjunct to ultrasound and is often appropriate for evaluation of the extent of placental invasiveness and potential involvement of adjacent structures. MRI is useful for preplanning for cases of complex delivery, which may necessitate a multi-disciplinary approach for optimal care.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.