ACR Appropriateness Criteria® Second and Third Trimester Vaginal Bleeding

Gyn, Expert Panel on; Imaging, OB; Shipp, Thomas; Pōder, Liina; Feldstein, Vickie A.; Oliver, Edward R.; Promes, Susan B.; Strachowski, Loretta M; Sussman, Betsy L; Wang, Eileen Y.; Weber, Therese M.; Winter, Tom; Glanc, Phyllis

doi:10.1016/j.jacr.2020.09.004

Cited by 8 publications

(3 citation statements)

References 44 publications

(42 reference statements)

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“…We reviewed relevant recommendations related to the 12 clinical/diagnostic scenarios previously published by radiology and specialty societies, including: the Canadian Association of Radiologists, 9 the American College of Obstetricians and Gynecologists, 10,11 the American College of Radiology, 12 -28 the American Society of Clinical Oncology, 29 the European Society of Urogenital Radiology Scrotal and Penile Imaging Working Group, 30,31 the European Society of Urogenital Radiology, 32 the French College of Gynecologists and Obstetricians, 33 the International Society of Ultrasound in Obstetrics and Gynecology, 34 the International guideline on polycystic ovarian syndrome, 35 -38 the National Institute for Health and Care Excellence, 39 -47 the Society for Maternal-Fetal Medicine, 48 the Society of Abdominal Radiology, 49 the Society of Obstetricians and Gynaecologists of Canada, 50 -57 the Royal College of Obstetricians and Gynaecologists, 58 -60 and the 2017 Royal College of Radiologists. 61…”

Section: Resultsmentioning

confidence: 99%

Canadian Association of Radiologists Obstetrics and Gynecology Diagnostic Imaging Referral Guideline

Hamel,

Amir,

Avard

et al. 2023

Can Assoc Radiol J

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The Canadian Association of Radiologists (CAR) Obstetrics and Gynecology Expert Panel consists of radiologists specializing in obstetrics and gynecology, obstetrics and gynecology physicians, a patient advisor, and an epidemiologist/guideline methodologist. After developing a list of 12 clinical/diagnostic scenarios, a systematic rapid scoping review was undertaken to identify systematically produced referral guidelines that provide recommendations for one or more of these clinical/diagnostic scenarios. Recommendations from 46 guidelines and contextualization criteria in the Grading of Recommendations, Assessment, Development and Evaluations (GRADE) for guidelines framework were used to develop 68 recommendation statements across the 12 scenarios related to the evaluation of obstetrics and gynecology clinical and diagnostic scenarios. This guideline presents the methods of development and the imaging recommendations for a variety of obstetrical and gynecological conditions including pregnancy assessment, recurrent first trimester pregnancy loss, post-partum indications, disorders of menstruation, localization of intra-uterine contraceptive device, infertility assessment, assessment of adnexal mass, pelvic pain of presumed gynecological origin, and pelvic floor evaluation.

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Section: Resultsmentioning

confidence: 99%

Canadian Association of Radiologists Obstetrics and Gynecology Diagnostic Imaging Referral Guideline

Hamel,

Amir,

Avard

et al. 2023

Can Assoc Radiol J

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“…Previously, it was reported that vaginal bleeding during the first and second trimesters of pregnancy had contributed to the risk of preterm birth associated with ultrasound cervical length [ 62 ]. It is noteworthy that physiological vaginal bleeding is observed in the event of a miscarriage, as well as labor-related cervical change, then termed as a “bloody show” usually preceding labor [ 63 ]. Therefore, the bleeding episodes found in our study are more common in the women with PTL and may have also been due to cervical remodeling rather than to a bleeding disorder and, hence, not influenced by changes, either in PT or APTT or PLT counts.…”

Section: Discussionmentioning

confidence: 99%

Association of Single Nucleotide Polymorphisms from Angiogenesis-Related Genes, ANGPT2, TLR2 and TLR9, with Spontaneous Preterm Labor

Wujcicka

Kacerovský

Krygier

et al. 2022

CIMB

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In this study, we hypothesized that the changes localized at angiopoietin-2 (ANGPT2), granulocyte-macrophage colony-stimulating factor (CSF2), fms-related tyrosine kinase 1 (FLT1) and toll-like receptor (TLR) 2, TLR6 and TLR9 genes were associated with spontaneous preterm labor (PTL), as well as with possible genetic alterations on PTL-related coagulation. This case-control genetic association study aimed to identify single nucleotide polymorphisms (SNPs) for the aforementioned genes, which are correlated with genetic risk or protection against PTL in Polish women. The study was conducted in 320 patients treated between 2016 and 2020, including 160 women with PTL and 160 term controls in labor. We found that ANGPT2 rs3020221 AA homozygotes were significantly less common in PTL cases than in controls, especially after adjusting for activated partial thromboplastin time (APTT) and platelet (PLT) parameters. TC heterozygotes for TLR2 rs3804099 were associated with PTL after correcting for anemia, vaginal bleeding, and history of threatened miscarriage or PTL. TC and CC genotypes in TLR9 rs187084 were significantly less common in women with PTL, compared to the controls, after adjusting for bleeding and gestational diabetes. For the first time, it was shown that three polymorphisms—ANGPT2 rs3020221, TLR2 rs3804099 and TLR9 rs187084 —were significantly associated with PTL, adjusted by pregnancy development influencing factors.

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“…Although ultrasound is the primary means of diagnosis, MRI may be used if the clinical situation warrants. 19 Magnetic resonance imaging can identify other causes of bleeding to include uterine leiomyoma; MRI T1-weighted imaging and T2-weighted imaging (T2WI) can also be helpful in determining length of time from the bleeding through characteristics of hemoglobin signals. 20 Blood from a recent or acute bleed is hypointense on T2WI and hyper-intense on T1-weighted imaging.…”

Section: Diagnosis and Imagingmentioning

confidence: 99%

Subchorionic Hemorrhage in the Second and Third Trimesters of Pregnancy: A Review

Pagan

Monson²,

Strebeck

et al. 2022

Obstetrical &Amp; Gynecological Survey

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ImportanceSubchorionic hemorrhage (SCH) in the second and third trimesters of pregnancy can be associated with maternal morbidity and fetal morbidity/mortality. Management of SCH in the second or third trimesters can be complicated, especially in the setting of a large SCH that requires hospitalization and blood transfusion.ObjectiveThe aim of this review is to describe SCH in second and third trimesters, risk factors, diagnosis, maternal and fetal outcomes, and management of this uncommon pregnancy complication.Evidence AcquisitionA PubMed, Web of Science, and CINAHL search was undertaken with no limitations on the number of years searched.ResultsThere were 123 abstracts and/or articles reviewed, with 48 articles being the basis of review. The only known risk factors for SCH are maternal factor deficiency and anticoagulation therapy. The diagnosis is usually made by ultrasound imaging. Subchorionic hemorrhage in second and third trimesters has been associated with several adverse fetal outcomes including preterm birth, preterm prelabor rupture of membranes, fetal growth restriction, fetal demise, and neonatal pulmonary morbidity. There is no proven treatment for SCH, although there are several investigational therapies reported.ConclusionsSubchorionic hemorrhage can be complex and difficult to manage in the second and third trimesters. There are no recommendations or guidelines for management; however, serial growth ultrasounds, umbilical artery Doppler studies, and antenatal fetal testing should be considered particularly if the SCH is large or treatment requires a maternal blood transfusion.RelevanceSubchorionic hemorrhage in the second and third trimester is associated with poor fetal outcomes and maternal morbidity, especially if the SCH is significant.Target AudienceObstetricians and gynecologists, midwives, family physicians.Learning ObjectivesAfter completion of this article, the reader should be better able to identify SCH in the second and third trimesters; describe potential complications associated with SCH; and predict adverse outcomes associated with SCH.

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ACR Appropriateness Criteria® Second and Third Trimester Vaginal Bleeding

Cited by 8 publications

References 44 publications

Canadian Association of Radiologists Obstetrics and Gynecology Diagnostic Imaging Referral Guideline

Canadian Association of Radiologists Obstetrics and Gynecology Diagnostic Imaging Referral Guideline

Association of Single Nucleotide Polymorphisms from Angiogenesis-Related Genes, ANGPT2, TLR2 and TLR9, with Spontaneous Preterm Labor

Subchorionic Hemorrhage in the Second and Third Trimesters of Pregnancy: A Review

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