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.
*Baptist Hospital of Miami/South Miami Center for Women and Infants, Miami, Florida; †Walter Reed National Military Medical Center, Bethesda, Maryland; ‡Sunnybrook Health Sciences Centre, Bayview Campus, Toronto, Ontario, Canada; §University of Washington School of Medicine, Seattle, Washington; ∥Massachusetts General Hospital, Boston Massachusetts; ¶Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire; #George Washington University Hospital, Washington, District of Columbia; **Thomas Jefferson University Hospital, Philadelphia, Pennsylvania; ††Massachusetts General Hospital, Boston Massachusetts; ‡‡Memorial Sloan Kettering Cancer Center, New York, New York; §§Brigham & Women’s Hospital, Boston, Massachusetts, American College of Obstetrics and Gynecology; ∥∥Mallinckrodt Institute of Radiology, St. Louis, Missouri; ¶¶Columbia University, New York, New York, American College of Obstetrics and Gynecology; ##Mayo Clinic, Rochester, Minnesota; ***University of Maryland School of Medicine, Baltimore, Maryland; and †††Valley Hospital, Ridgewood, New Jersey, American College of Obstetrics and Gynecology.
Received for publication August 15, 2013; accepted September 22, 2013.
The authors declare no conflict of interest.
The American College of Radiology seeks and encourages collaboration with other organizations on the development of the ACR Appropriateness Criteria through society representation on expert panels. Participation by representatives from collaborating societies on the expert panel does not necessarily imply individual or society endorsement of the final document.
Reprints: Ann E. Podrasky, MD, Baptist Hospital of Miami/South Miami Center for Women and Infants, 130 Solano Prado, Coral Gables, FL 33156 (e-mail: firstname.lastname@example.org).
Reprint requests to: Department of Quality & Safety, American College of Radiology, 1891 Preston White Drive, Reston, VA 20191-4397.