2018ACR适宜性标准：妊娠早期阴道出血.pdfVIP

APPROPRIATE USE CRITERIA ACR Appropriateness Criteriaâ First Trimester Vaginal Bleeding a b Expert Panel on Women’s Imaging: Douglas L. Brown, MD , Ann Packard, MD , c d e Katherine E. Maturen, MD, MS , Sandeep Prakash Deshmukh, MD , Kika M. Dudiak, MD , Tara L. Henrichsen, MDe f g h , Benjamin J. Meyer, MD , Liina Poder, MD , Elizabeth A. Sadowski, MD , i j k l Thomas D. Shipp, MD, RDMS , Lynn Simpson, MD , Therese M. Weber, MD , Carolyn M. Zelop, MD , Phyllis Glanc, MDm Abstract Vaginal bleeding is not uncommon in the first trimester of pregnancy. The majority of such patients will have a normal intrauterine pregnancy (IUP), a nonviable IUP, or an ectopic pregnancy. Ultrasound (US) is the primary imaging modality in evaluation of these patients. US, along with clinical observations and serum human chorionic gonadotropin levels, can usually distinguish these causes. Although it is important to diagnose ectopic pregnancies and nonviable IUPs, one should also guard against injury to normal pregnancies due to inappropriate treatment with methotrexate or surgical intervention. Less common causes of first trimester vaginal bleeding include gestational trophoblastic disease and arteriovenous malformations. Pulsed methods of Doppler US should generally be avoided in the first trimester when there is a normal, or a potentially n