ACR appropriateness criteria® second and third trimester bleeding

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

Research output: Contribution to journalArticlepeer-review

7 Scopus citations


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.

Original languageEnglish (US)
Pages (from-to)293-301
Number of pages9
JournalUltrasound Quarterly
Issue number4
StatePublished - Dec 2013


  • Appropriateness Criteria
  • Placenta accreta
  • Placenta previa
  • Placental abruption
  • Vaginal bleeding
  • Vasa previa

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging


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