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Appropriateness Criteria

Reference Study Type Patients/Events Study Objective(Purpose of Study) Study Results Study Quality
1. Al-Memar M, Vaulet T, Fourie H, et al. Early-pregnancy events and subsequent antenatal, delivery and neonatal outcomes: prospective cohort study. Ultrasound Obstet Gynecol. 54(4):530-537, 2019 Oct. Review/Other-Dx 1,003 women To assess prospectively the association between pelvic pain, vaginal bleeding, and nausea and vomiting occurring in the first trimester of pregnancy and the incidence of later adverse pregnancy outcomes. Of 1003 women recruited, 847 pregnancies were included in the final analysis following exclusion of cases due to first-trimester miscarriage (n = 99), termination of pregnancy (n = 20), loss to follow-up (n = 32) or withdrawal from the study (n = 5). Adverse antenatal complications were observed in 166/645 (26%) women with pelvic pain and/or vaginal bleeding in the first trimester (aOR = 1.79; 95% CI, 1.17-2.76) and in 30/181 (17%) women with no symptoms. Neonatal complications were observed in 66/634 (10%) women with and 11/176 (6%) without pelvic pain and/or vaginal bleeding (aOR = 1.73; 95% CI, 0.89-3.36). Delivery complications were observed in 402/615 (65%) women with and 110/174 (63%) without pelvic pain and/or vaginal bleeding during the first trimester (aOR = 1.16; 95% CI, 0.81-1.65). For 18 of 20 individual antenatal complications evaluated, incidence was higher among women with pelvic pain and/or vaginal bleeding, despite the overall incidences being low. Nausea and vomiting in pregnancy showed little association with adverse pregnancy outcomes. 4
2. Hasan R, Baird DD, Herring AH, Olshan AF, Jonsson Funk ML, Hartmann KE. Patterns and predictors of vaginal bleeding in the first trimester of pregnancy. Ann Epidemiol. 2010;20(7):524-531. Review/Other-Dx 4,539 patients To characterize the patterns and predictors of early pregnancy bleeding, setting aside bleeding episodes that occur at the time of miscarriage. Approximately one-fourth of participants (n=1,207) reported bleeding (n=1,656 episodes), but only 8% of women with bleeding, reported heavy bleeding. Of the spotting and light bleeding episodes (n=1,555), 28% were associated with pain. Among heavy episodes (n=100), 54% were associated with pain. Most episodes lasted less than 3 days, and most occurred between gestational weeks 5–8. 12% of women with bleeding and 13% of those without experienced miscarriage. Maternal characteristics associated with bleeding included fibroids and prior miscarriage. Consistent with the hypothesis that bleeding is a marker for placental dysfunction, bleeding is most likely to be seen around the time of the luteal-placental shift. 4
3. Phillips CH, Wortman JR, Ginsburg ES, Sodickson AD, Doubilet PM, Khurana B. First-trimester emergencies: a radiologist's perspective. [Review]. EMERG. RADIOL.. 25(1):61-72, 2018 Feb. Review/Other-Dx N/A To help the practitioner ensure early diagnosis and response to emergencies in the first trimester by reviewing anatomy of the developing embryo, highlighting the sonographic appearance of common first-trimester emergencies, and discussing key management pathways for treating emergent cases. No results stated in abstract. 4
4. Pedigo R. First trimester pregnancy emergencies: recognition and management. Emergency Medicine Practice. 21(1):1-20, 2019 Jan.Emerg. med. pract.. 21(1):1-20, 2019 Jan. Review/Other-Dx N/A Review the various imaging modalities available for pregnant patients and reviews the risks of ionizing radiation as well as various contrast media. No results stated in abstract. 4
5. Kao LY, Scheinfeld MH, Chernyak V, Rozenblit AM, Oh S, Dym RJ. Beyond ultrasound: CT and MRI of ectopic pregnancy. [Review]. AJR Am J Roentgenol. 202(4):904-11, 2014 Apr. Review/Other-Dx N/A To discuss various forms of ectopic pregnancy and its complications that may occasionally be further evaluated with MRI or may be incidentally detected on CT or MRI when an alternative diagnosis is suspected. No results stated in abstract. 4
6. Shin DS, Poder L, Courtier J, Naeger DM, Westphalen AC, Coakley FV. CT and MRI of early intrauterine pregnancy. AJR Am J Roentgenol. 196(2):325-30, 2011 Feb. Review/Other-Dx N/A To describe the CT and MRI findings of early intrauterine pregnancy. No results listed in abstract. 4
7. American College of Radiology. ACR Committee on Drugs and Contrast Media. Manual on Contrast Media.  Available at: https://www.acr.org/Clinical-Resources/Clinical-Tools-and-Reference/Contrast-Manual. Review/Other-Dx N/A Guidance document to assist radiologists in recognizing and managing the small but real risks inherent in the use of contrast media. No abstract available. 4
8. Sellmyer MA, Desser TS, Maturen KE, Jeffrey RB, Jr., Kamaya A. Physiologic, histologic, and imaging features of retained products of conception. Radiographics 2013;33:781-96. Review/Other-Dx N/A To review the physiologic, histologic, and imaging features of retained products of conception No results listed in abstract. 4
9. American College of Radiology. ACR Committee on MR Safety. 2024 ACR Manual on MR Safety.  Available at: https://edge.sitecorecloud.io/americancoldf5f-acrorgf92a-productioncb02-3650/media/ACR/Files/Clinical/Radiology-Safety/Manual-on-MR-Safety.pdf. Review/Other-Dx N/A Guidance document to promote the use of magnetic resonance (MR) safe practices. No abstract available. 4
10. Liu W, Xie W, Zhao H, et al. Using MRI to differentiate upper-lateral intracavitary pregnancy and interstitial pregnancy for the patients with pregnancies in the uterotubal junction during the first trimester. Eur Radiol. 32(10):6619-6627, 2022 Oct. Observational-Dx 59 patients To retrospectively evaluate the diagnostic value of MRI for the uterotubal junctional pregnancies during the first trimester. The endometrial thickness in the upper-lateral intracavitary pregnancy group was larger than in the interstitial group (p = 0.001). The cutoff value of the endometrial thickness was 11.5 mm with a sensitivity, specificity, and area under the curve that were 77.3%, 64.9%, and 0.743, respectively. Two key features to diagnose upper-lateral intracavitary pregnancy were "medial free edge" and "medial free edge plus above-cutoff endometrial thickness." The sensitivity and specificity of the medial free edge were 100% and 94.9%, respectively. The sensitivity and specificity of the medial free edge plus above-cutoff endometrial thickness were 77.3% and 100%, respectively. The key feature to diagnose interstitial pregnancy was an "intact lateral junctional zone," of which the sensitivity and specificity were 94.6% and 100%, respectively. 3
11. Ray JG, Vermeulen MJ, Bharatha A, Montanera WJ, Park AL. Association Between MRI Exposure During Pregnancy and Fetal and Childhood Outcomes. JAMA. 2016;316(9):952-961. Observational-Dx 1,424,105 children To evaluate the long-term safety after exposure to MRI in the first trimester of pregnancy or to gadolinium at any time during pregnancy. Of 1424105 deliveries (48% girls; mean gestational age, 39 weeks), the overall rate of MRI was 3.97 per 1000 pregnancies. Comparing first-trimester MRI (n = 1737) to no MRI (n = 1418451), there were 19 stillbirths or deaths vs 9844 in the unexposed cohort (adjusted relative risk [RR], 1.68; 95% CI, 0.97 to 2.90) for an adjusted risk difference of 4.7 per 1000 person-years (95% CI, -1.6 to 11.0). The risk was also not significantly higher for congenital anomalies, neoplasm, or vision or hearing loss. Comparing gadolinium MRI (n = 397) with no MRI (n = 1418451), the hazard ratio for NSF-like outcomes was not statistically significant. The broader outcome of any rheumatological, inflammatory, or infiltrative skin condition occurred in 123 vs 384180 births (adjusted HR, 1.36; 95% CI, 1.09 to 1.69) for an adjusted risk difference of 45.3 per 1000 person-years (95% CI, 11.3 to 86.8). Stillbirths and neonatal deaths occurred among 7 MRI-exposed vs 9844 unexposed pregnancies (adjusted RR, 3.70; 95% CI, 1.55 to 8.85) for an adjusted risk difference of 47.5 per 1000 pregnancies (95% CI, 9.7 to 138.2). 3
12. Peng KW, Lei Z, Xiao TH, et al. First trimester caesarean scar ectopic pregnancy evaluation using MRI. Clin Radiol. 69(2):123-9, 2014 Feb. Observational-Dx 39 patients To determine the features of caesarean scar ectopic pregnancy (CSP) by using magnetic resonance imaging (MRI) in the first trimester. The CSPs were categorized into three groups: type I, in which a thin-walled diverticulum is present at the caesarean section scar (CSS) defect and the gestational sac (GS) is embedded in the diverticulum; type II, in which a thin-walled diverticulum is present at the CSS defect and the GS is partially embedded in the diverticulum; type III, in which a niche is present in the CSS defect and the GS is mainly embedded in the isthmus. Types I, II, and III CSP occurred in 40, 46, and 14% of the women, respectively. There was no significant difference between the three types in the minimum thickness of the CSS defect. In types I and II, there was a positive correlation in the maximum inlet diameter of the CSS defect and the approximate area of the GS. 3
13. Ucisik-Keser FE, Matta EJ, Fabrega MG, Chandrasekhar C, Chua SS. The many faces of ectopic pregnancies: demystifying the common and less common entities. [Review]. Abdom Radiol. 46(3):1104-1114, 2021 03. Review/Other-Dx N/A To review the imaging findings and mimickers of ectopic pregnancies. No results stated in abstract. 4
14. Hugues C, Le Bras Y, Coatleven F, et al. Vascular uterine abnormalities: Comparison of imaging findings and clinical outcomes. Eur J Radiol. 84(12):2485-91, 2015 Dec. Observational-Dx 38 women. To retrospectively compare the imaging findings and the outcomes for patients with vascular uterine abnormalities (VUA) and to identify prognostic factors. No information about severity was provided by US, MRI or CT. Twelve patients were successfully managed conservatively. Angiography identified 6 non-severe VUA, corresponding to an isolated uterine hyperemia, and 20 severe VUA, corresponding to an association of a nidus and early venous drainage. Recurrences were more often observed for severe VUA (p=0.001). The hemoglobin level was significantly lower (below 11 g/L) in these cases (p=0.004). Recurrences were significantly more frequently observed for patients with history of dilatation and curettage (p=0.02). Hysterectomy was performed for three patients only (8%). Among the women who wished to have children, 14 (77.8%) were pregnant after 9 months in mean (range 2-23). 2
15. Amran UN, Zaiki FWA, Dom SM. A Review of the Thermal Effects During Pregnancy by Using Ultrasound: Doppler Mode. Pertanika J. Sci. Technol 2019;27:357-70. Review/Other-Dx N/A To discuss the thermally induced effect of ultrasound by using Doppler mode. No results stated in abstract. 4
16. Salvesen K, Abramowicz J, Ter Haar G, et al. ISUOG statement on the safe use of Doppler for fetal ultrasound examination in the first 13 + 6 weeks of pregnancy (updated). Ultrasound Obstet Gynecol 2021;57:1020. Review/Other-Dx N/A Statement on the safe use of Doppler for fetal ultrasound examination in the first 13?+?6?weeks of pregnancy No results stated in abstract. 4
17. Frates MC, Doubilet PM, Peters HE, Benson CB. Adnexal sonographic findings in ectopic pregnancy and their correlation with tubal rupture and human chorionic gonadotropin levels. J Ultrasound Med. 33(4):697-703, 2014 Apr. Observational-Dx 231 pregnancies To determine whether the distribution of transvaginal sonographic findings of ectopic pregnancy has changed since the studies done 20 years ago and to explore the correlation of tubal rupture with transvaginal sonographic findings and human chorionic gonadotropin (hCG) levels. Our study included 231 ectopic pregnancies. A positive sonographic adnexal finding was present in 219 cases (94.8%): adnexal mass in 218 (94.4%) and a moderate-to-large amount of free fluid in 84 (36.4%). The adnexal masses were graded as follows: 1, nonspecific mass (125 cases [54.1% of total]); 2, tubal ring without a yolk sac or embryo (57 [24.7%]); 3, yolk sac but no embryonic heartbeat (19 [8.3%]); and 4, embryo with cardiac activity (17 [7.4%]). The mean hCG level increased as the grade ascended from 1 to 4. Thirty-six patients had tubal rupture at surgery within 24 hours of the sonogram. A moderate-to-large amount of free fluid was significantly associated with tubal rupture (P < .05) but had low sensitivity, specificity, and positive predictive value for rupture. Other sonographic findings and hCG levels were not significantly related to tubal rupture. 3
18. Rodgers SK, Horrow MM, Doubilet PM, et al. A Lexicon for First-Trimester US: Society of Radiologists in Ultrasound Consensus Conference Recommendations. Am J Obstet Gynecol 2024. Review/Other-Dx N/A To develop a first-trimester US lexicon based on scientific evidence, societal guidelines, and expert consensus that would be appropriate for imagers, clinicians, and patients. No results stated in abstract. 4
19. Doubilet PM, Phillips CH, Durfee SM, Benson CB. First-Trimester Prognosis When an Early Gestational Sac is Seen on Ultrasound Imaging: Logistic Regression Prediction Model. J Ultrasound Med. 40(3):541-550, 2021 Mar. Review/Other-Dx 590 To determine the factors that jointly and independently affect first-trimester outcome of very early intrauterine pregnancies (those whose sonogram shows a gestational sac with no identifiable yolk sac or embryo) and develop a mathematical model and Web-based calculator that computes prognosis based on these factors. Patient age, MSD, hCG rise, vaginal bleeding, history of infertility, and assisted reproductive technology pregnancy were significantly correlated with outcome (P < .05, t test for age and MSD, ?2 for the others). Stepwise logistic regression identified age, MSD, hCG rise, and vaginal bleeding as the subset of factors that independently predicted outcome. The regression model's area under the receiver operating characteristic curve was 0.823. We incorporated the regression model into a Web-based calculator (https://tinyurl.com/Prognosis-PD) that predicts the outcome of an early intrauterine pregnancy based on these 4 key variables. 4
20. Phillips CH, Benson CB, Durfee SM, Heller HT, Doubilet PM. "Pseudogestational Sac" and Other 1980s-Era Concepts in Early First-Trimester Ultrasound: Are They Still Relevant Today?. J Ultrasound Med. 39(8):1547-1551, 2020 Aug. Review/Other-Dx 649 sonograms To determine whether an intrauterine round or oval fluid collection ("saclike structure") can prove to be either an intrauterine pregnancy or intrauterine fluid in conjunction with an ectopic pregnancy (sometimes termed "pseudogestational sac") and whether ultrasound features, including the presence or absence of an echogenic rim, "double sac sign" (DSS), or "intradecidual sign" (IDS), are helpful for establishing the diagnosis or predicting the prognosis. A total of 649 sonograms met the inclusion criteria. Of these, 598 fluid collections showed an echogenic rim, 182 a DSS, and 347 an IDS (findings not mutually exclusive). In all 649 cases, a subsequent sonogram or other clinical follow-up confirmed that the patient had an intrauterine pregnancy. That is, none of the fluid collections proved to be a pseudogestational sac. In total, 41.2% were live at the end of the first trimester, and 58.8% miscarried. The prognosis was better in cases with, compared to without, an IDS (P = .01, ?2 ), but no ultrasound feature was clinically useful for ruling in or excluding a good prognosis. 4
21. Connolly A, Ryan DH, Stuebe AM, Wolfe HM. Reevaluation of discriminatory and threshold levels for serum beta-hCG in early pregnancy. Obstet Gynecol. 2013;121(1):65-70. Review/Other-Dx 651 pregnancies To reevaluate both discriminatory and threshold levels associated with visualization of gestational sacs, yolk sacs, and fetal poles in patients presenting with vaginal bleeding, pain, or vaginal bleeding and pain in the first trimester of pregnancy using current US technology. 651 pregnancies met inclusion criteria; 366 were viable. Discriminatory beta-hCG levels at which structures would be predicted to be seen 99% of the time were 3,510 mIU/mL, 17,716 mIU/mL, and 47,685 mIU/mL for gestational sac, yolk sac, and fetal pole, respectively. In this population, threshold values for beta-hCG levels at which these structures could be seen were 390 mIU/mL, 1,094 mIU/mL, and 1,394 mIU/mL, respectively. 4
22. Doubilet PM, Benson CB, Bourne T, et al. Diagnostic criteria for nonviable pregnancy early in the first trimester. N Engl J Med. 2013;369(15):1443-1451. Review/Other-Dx N/A Diagnostic criteria for nonviable pregnancy early in the first trimester. No results stated in abstract. 4
23. Ko JK, Cheung VY. Time to revisit the human chorionic gonadotropin discriminatory level in the management of pregnancy of unknown location. J Ultrasound Med. 33(3):465-71, 2014 Mar. Review/Other-Dx 113 patients To review the management and outcomes of all patients with pregnancy of unknown location who had serum human chorionic gonadotropin (hCG) levels greater than 1000 mIU/mL in our institution and to determine the likelihood of a subsequent normal intrauterine pregnancy at different hCG discriminatory levels. A total of 113 patients were identified. There were 23 viable intrauterine pregnancies (20.4%) and 22 visualized ectopic pregnancies (19.5%). The highest hCG level associated with a subsequent normal intrauterine pregnancy was 9083 mIU/mL in a patient with triplet pregnancy. Possible factors associated with nonvisualization of a normal intrauterine pregnancy included uterine fibroids, adenomyosis, endometrial polyps, and obesity. The negative laparoscopy rate was 48.8%. 4
24. Tuuli MG, Norman SM, Odibo AO, Macones GA, Cahill AG. Perinatal outcomes in women with subchorionic hematoma: a systematic review and meta-analysis. Obstet Gynecol 2011;117:1205-12. Meta-analysis 7studies 1,735 women To estimate the association between subchorionic hematoma and adverse perinatal outcomes. Seven studies including 1,735 women with subchorionic hematoma and 70,703 controls met inclusion criteria. Subchorionic hematoma was associated with an increased risk of spontaneous abortion (from 8.9% to 17.6%; pooled OR 2.18, 95% confidence interval [CI] 1.29–3.68) and stillbirth (from 0.9% to 1.9%, pooled OR 2.09, 95% CI 1.20–3.67). The number needed to harm was 11 for spontaneous abortion and 103 for stillbirth, meaning one extra spontaneous abortion is estimated to occur for every 11 women with subchorionic hematoma diagnosed and one extra stillbirth occurs for every 103 women with subchorionic hematoma diagnosed. Women with subchorionic hematoma were also at increased risk of abruption (from 0.7% to 3.6%, pooled OR 5.71, 95% CI 3.91–8.33), preterm delivery (from 10.1% to 13.6%, pooled OR 1.40, 95% CI 1.18–1.68), and preterm premature rupture of membranes (from 2.3% to 3.8%, pooled OR 1.64, 95% CI 1.22–2.21), but not small for gestational age (OR 1.69, 95% CI 0.89–3.19) or pre-eclampsia (OR 1.47, 95% CI 0.37–5.89). The numbers needed to harm were 34, 28, and 69 for abruption, preterm delivery, and preterm premature rupture of membranes, respectively. Good
25. Al-Memar M, Vaulet T, Fourie H, et al. First-trimester intrauterine hematoma and pregnancy complications. Ultrasound Obstet Gynecol. 55(4):536-545, 2020 04. Review/Other-Dx 946 To assess whether sonographic diagnosis of intrauterine hematoma (IUH) in the first trimester of pregnancy is associated with first-trimester miscarriage and antenatal, delivery and neonatal complications. Of 1003 women recruited to the study, 946 were included in the final analysis and of these, 268 (28.3%) were diagnosed with an IUH in the first trimester. The presence of IUH was associated with the incidence of preterm birth (aOR, 1.94 (95% CI, 1.07-3.52)), but no other individual or overall antenatal, delivery or neonatal complications. No association was found between the presence of IUH in the first trimester and first-trimester miscarriage (aOR, 0.81 (95% CI, 0.44-1.50)). These findings were independent of the absolute size of the hematoma and the presence of vaginal bleeding or pelvic pain in the first trimester. When IUH was present in the first trimester, there was no association between its size, content or position in relation to the gestational sac and overall antenatal, delivery and neonatal complications. Diagnosis of a retroplacental IUH was associated with an increased risk of overall antenatal complications (P = 0.04). 4
26. Murugan VA, Murphy BO, Dupuis C, Goldstein A, Kim YH. Role of ultrasound in the evaluation of first-trimester pregnancies in the acute setting. Ultrasonography 2020;39:178-89. Review/Other-Dx N/A To review the sonographic appearance of a normal intrauterine gestation and the most common complications of pregnancy in the first trimester in the acute setting are discussed. No results stated in abstract. 4
27. Naert MN, Khadraoui H, Muniz Rodriguez A, Naqvi M, Fox NS. Association Between First-Trimester Subchorionic Hematomas and Pregnancy Loss in Singleton Pregnancies. Obstet Gynecol. 134(2):276-281, 2019 08. Review/Other-Dx 2,446 women To assess the association of a first-trimester subchorionic hematoma with pregnancy loss in women with singleton pregnancies. From January 2015 to December 2017, a total of 2,446 women met inclusion criteria, 451 (18.4%) of whom had subchorionic hematomas. Women with subchorionic hematomas had their first ultrasound scans at an earlier gestational age (8 5/7 vs 9 6/7 weeks of gestation, P<.001) and were more likely to have vaginal bleeding (33.3% vs 8.1%, P<.001). Maternal age, race, use of in vitro fertilization, body mass index, prior number of losses, and medical comorbidities did not differ between the groups. On univariable analysis, subchorionic hematoma was associated with an increased risk of pregnancy loss before 20 weeks of gestation (7.5% vs 4.9%, P=.026); however, after adjusting for gestational age and vaginal bleeding, this association was no longer significant (adjusted odds ratio 1.13, 95% CI 0.74-1.74). In the 451 women with subchorionic hematomas, no characteristics of the subchorionic hematoma, including size by volume, largest diameter, presence of vaginal bleeding, and presence of an additional subchorionic hematoma, were associated with pregnancy loss. Post hoc power analysis showed we had 80% power to detect an increase in pregnancy loss before 20 weeks of gestation from 4.9% in women with no subchorionic hematoma to 8.3% in women with subchorionic hematoma. 4
28. Fu Z, Ding X, Wei D, Li J, Cang R, Li X. Impact of subchorionic hematoma on pregnancy outcomes in women with recurrent pregnancy loss. Biomol Biomed 2023;23:170-75. Review/Other-Dx 274 To investigate the relationship between subchorionic hematoma (SCH) and pregnancy outcomes in women with recurrent pregnancy loss (RPL). Two groups were divided according to the presence or absence of SCH. Live birth rate was considered as the primary outcome. Secondary outcomes included adverse pregnancy outcomes and complications. Univariable and multivariable analyses were conducted. Of 274 RPL women included in the final analysis, 49 (17.9%) had SCH. The occurrence of thrombophilia was significantly higher in SCH group than that in non-SCH group (38.8% vs 24.4%, P=0.041). There were no significant differences between the two groups in live birth rate, adverse pregnancy outcomes and pregnancy complications. Among women with SCH, live birth rate or SCH duration was not associated with continued use of low-dose aspirin (LDA) after the diagnosis of SCH. 4
29. Gunay T, Yardimci OD. How does subchorionic hematoma in the first trimester affect pregnancy outcomes? Arch Med Sci 2022;18:639-46. Review/Other-Dx 178 To investigate the association of SCH with adverse pregnancy outcomes in pregnant women in relation to size of hematoma and control subjects. Subchorionic hematoma was associated with significantly lower gestational age at delivery (p < 0.001) and higher rate of first trimester bleeding (p < 0.001) compared with the control group, regardless of the size of the hematoma. Placental abruption (p = 0.002) and early pregnancy loss (p < 0.001) were significantly more common in SCH-II and -III groups than in the control group. SCH-III group was associated with a significantly higher rate of < 37 gestational weeks at delivery (p < 0.001), first trimester vaginal bleeding (p < 0.001), early pregnancy loss (p < 0.001), IUGR (p = 0.003) and preterm delivery (p < 0.001) compared to both lesser size hematoma and control groups. 4
30. Doubilet PM, Phillips CH, Durfee SM, Benson CB. Fourfold Improved Odds of a Good First Trimester Outcome Once a Yolk Sac Is Seen in Early Pregnancy. J Ultrasound Med. 41(11):2835-2840, 2022 Nov. Review/Other-Dx 823 transvaginal sonograms To compare first trimester prognosis when an early pregnancy sonogram demonstrates a gestational sac with yolk sac versus gestational sac without yolk sac. At the end of the first trimester, 113 of 270 (41.9%) cases without a yolk sac and 414 of 553 (74.9%) with a yolk sac were live (P < .000001, chi-square). This corresponds to an odds ratio of 4.14 for the presence of yolk sac, a result confirmed by logistic regression. Advanced maternal age, =42 days since LMP, and vaginal bleeding all carried an increased risk of loss (P < .000001, chi-square). Outcome was better with a visualized yolk sac than without a yolk sac, regardless of number of risk factors (P < .001, chi-square). 4
31. Hendriks E, MacNaughton H, MacKenzie MC. First Trimester Bleeding: Evaluation and Management. [Review]. Am Fam Physician. 99(3):166-174, 2019 02 01. Review/Other-Dx N/A Established criteria should be used to determine treatment options for ectopic pregnancy, including expectant management, medical management with methotrexate, or surgical intervention. No results stated in abstract. 4
32. Preisler J, Kopeika J, Ismail L, et al. Defining safe criteria to diagnose miscarriage: prospective observational multicentre study. BMJ. 351:h4579, 2015 Sep 23. Observational-Dx 2845 women To validate recent guidance changes by establishing the performance of cut-off values for embryo crown-rump length and mean gestational sac diameter to diagnose miscarriage with high levels of certainty. Secondary aims were to examine the influence of gestational age on interpretation of mean gestational sac diameter and crown-rump length values, determine the optimal intervals between scans and findings on repeat scans that definitively diagnose pregnancy failure.) The following indicated a miscarriage at initial scan: mean gestational sac diameter >/= 25 mm with an empty sac (364/364 specificity: 100%, 95% confidence interval 99.0% to 100%), embryo with crown-rump length >/= 7 mm without visible embryo heart activity (110/110 specificity: 100%, 96.7% to 100%), mean gestational sac diameter >/= 18 mm for gestational sacs without an embryo presenting after 70 days' gestation (907/907 specificity: 100%, 99.6% to 100%), embryo with crown-rump length >/= 3 mm without visible heart activity presenting after 70 days' gestation (87/87 specificity: 100%, 95.8% to 100%). The following were indicative of miscarriage at a repeat scan: initial scan and repeat scan after seven days or more showing an embryo without visible heart activity (103/103 specificity: 100%, 96.5% to 100%), pregnancies without an embryo and mean gestational sac diameter <12 mm where the mean diameter has not doubled after 14 days or more (478/478 specificity: 100%, 99.2% to 100%), pregnancies without an embryo and mean gestational sac diameter >/= 12 mm showing no embryo heartbeat after seven days or more (150/150 specificity: 100%, 97.6% to 100%). 3
33. American College of Obstetricians and Gynecologists' Committee on Practice Bulletins—Gynecology. ACOG Practice Bulletin No. 200: Early Pregnancy Loss. Obstet Gynecol 2018;132:e197-e207. Review/Other-Dx N/A The purpose of this Practice Bulletin is to review diagnostic approaches and describe options for the management of early pregnancy loss. No results stated in abstract. 4
34. Tanaka Y, Mimura K, Kanagawa T, et al. Three-dimensional sonography in the differential diagnosis of interstitial, angular, and intrauterine pregnancies in a septate uterus. J Ultrasound Med 2014;33:2031-5. Review/Other-Dx N/A To demonstrate the differences in diagnostic imaging findings and emphasize the importance of 3D sonography in differentiating these entities. No results stated in abstract. 4
35. Cali G, Forlani F, Timor-Tritsch IE, Palacios-Jaraquemada J, Minneci G, D'Antonio F. Natural history of Cesarean scar pregnancy on prenatal ultrasound: the crossover sign. Ultrasound Obstet Gynecol. 50(1):100-104, 2017 Jul. Review/Other-Dx 68 To ascertain the performance of prenatal ultrasound in predicting the natural history of CSP using a new sonographic sign, the crossover sign (COS). Sixty-eight pregnancies with MAP were included. The risk of placenta percreta was significantly higher in pregnancies with COS-1 than in those with COS-2 (OR, 6.67 (95% CI, 1.3-33.3)). When evaluating the two variants of COS-2 separately, the risk of placenta percreta was significantly higher in pregnancies with COS-1 vs COS-2+ (OR, 5.83 (95% CI, 1.1-30.2)) and this risk was even higher when comparing cases with COS-1 vs COS-2- (OR, 12.0 (95% CI, 1.9-75.7)). Logistic regression analysis showed that COS-1 was associated independently with severe forms of MAP, such as placenta percreta and increta (OR, 12.85 (95% CI, 2.0-84.0)), while COS-2+ was associated independently with placenta accreta (OR, 4.37 (95% CI, 1.1-17.0)). 4
36. Savage JL, Maturen KE, Mowers EL, et al. Sonographic diagnosis of partial versus complete molar pregnancy: A reappraisal. J Clin Ultrasound 2017;45:72-78. Observational-Dx 70 women To assess the prospective sonographic diagnosis of molar pregnancy and compare sonographic features of complete versus partial molar pregnancy. Mean age of patients was 30.5 +/- 7.0 (SD) years (range, 16-49 years) with a mean gravidity of 3.2 +/- 2.3 (SD) (range 1-11). Mean gestational age was 74.0 +/- 19.1 day (range 39-138) and serum beta-human chorionic gonadotropin was 131 +/- 156 mIU/ml (range 447-662,000). Pathologic results showed 48 partial and 22 complete molar pregnancies. Sonographically, partial moles more commonly showed a yolk sac (56.3% versus 0%, p < 0.0001), fetal pole (62.5% versus 4.6%, p < 0.0001), fine septa within the sac (25.0% versus 4.6%, p = 0.05), and normal (31.3% versus 0%, p = 0.002) or minimally cystic placenta (27.1% versus 4.6%, p = 0.49), while complete moles had larger gestational sacs (612 versus 44 mm, p = 0.005), were more often avascular on color Doppler imaging (45.5% versus 18.8%, p = 0.02), had more often abnormal tissue in the uterus (82.6% versus 20.8%, p < 0.0001) and placental masses (86.9% versus 16.7%, p < 0.0001), and were more often diagnosed prospectively (86.4% versus 41.7%, p = 0.0005). 2
37. American College of Radiology. ACR–SPR Practice Parameter for the Safe and Optimal Performance of Fetal Magnetic Resonance Imaging (MRI). Available at: https://gravitas.acr.org/PPTS/GetDocumentView?docId=89+&releaseId=2. Review/Other-Dx N/A To promote safe and optimal performance of fetal magnetic resonance imaging (MRI). No abstract available. 4
38. American College of Radiology. ACR-SPR Practice Parameter for Imaging Pregnant or Potentially Pregnant Patients with Ionizing Radiation.  Available at: https://gravitas.acr.org/PPTS/GetDocumentView?docId=23+&releaseId=2. Review/Other-Dx N/A To assist practitioners in providing appropriate radiologic care for pregnant or potentially pregnant adolescents and women by describing specific training, skills and techniques. No abstract available. 4
39. American College of Radiology. ACR-ACOG-AIUM-SMFM-SRU Practice Parameter for the Performance of Standard Diagnostic Obstetrical Ultrasound. Available at: https://gravitas.acr.org/PPTS/GetDocumentView?docId=28+&releaseId=2. Review/Other-Dx N/A To promote the safe and effective use of diagnostic and therapeutic radiology by describing the key elements of standard ultrasound examinations in the first, second, and third trimesters of pregnancy. No abstract available. 4
40. National Academies of Sciences, Engineering, and Medicine; Division of Behavioral and Social Sciences and Education; Committee on National Statistics; Committee on Measuring Sex, Gender Identity, and Sexual Orientation. Measuring Sex, Gender Identity, and Sexual Orientation. In: Becker T, Chin M, Bates N, eds. Measuring Sex, Gender Identity, and Sexual Orientation. Washington (DC): National Academies Press (US) Copyright 2022 by the National Academy of Sciences. All rights reserved.; 2022. Review/Other-Dx N/A Sex and gender are often conflated under the assumptions that they are mutually determined and do not differ from each other; however, the growing visibility of transgender and intersex populations, as well as efforts to improve the measurement of sex and gender across many scientific fields, has demonstrated the need to reconsider how sex, gender, and the relationship between them are conceptualized. No abstract available. 4
41. American College of Radiology. ACR Appropriateness Criteria® Radiation Dose Assessment Introduction. Available at: https://edge.sitecorecloud.io/americancoldf5f-acrorgf92a-productioncb02-3650/media/ACR/Files/Clinical/Appropriateness-Criteria/ACR-Appropriateness-Criteria-Radiation-Dose-Assessment-Introduction.pdf. Review/Other-Dx N/A To provide evidence-based guidelines on exposure of patients to ionizing radiation. No abstract available. 4
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