ACR Appropriateness Criteria® Multiple Gestations

Abstract

Multiple gestations are high-risk compared with singleton pregnancies. Prematurity and intrauterine growth restrictions are the major sources of morbidity and mortality common to all twin gestations. Monochorionic twins are at a higher risk for twin-twin transfusion, fetal growth restriction, congenital anomalies, vasa previa, velamentous insertion of the umbilical cord and fetal death. Therefore, determination of multiple gestation, amnionicity and chorionicity in the first trimester is important. Follow up examinations to evaluate fetal well-being include assessment of fetal growth and amniotic fluid volume, umbilical artery Doppler, nonstress test and biophysical profile. To date, there is a paucity of literature regarding imaging schedules for follow-up. At the very least, antepartum testing in multiple gestations is recommended in all situations in which surveillance would ordinarily be performed in a singleton pregnancy.The ACR Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed biennially 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 procedures by the panel. In those instances where evidence is lacking or not definitive, expert opinion may be used to recommend imaging.

Delphi approach to select rare diseases for a European representative survey. The BURQOL-RD study

“…Despite the widespread use of Delphi methods in the existing literature [9][10][11][12][13][14]21,22], not much attention has been applied in cross-country settings. The lack of specific validation can be considered a limitation of this study.…”

“…Provision for feedback and opportunity to revise earlier responses obviously requires that the technique has at least two rounds [20]. In fact, the modified Delphi method based on internet dissemination of two consecutive consultation rounds is commonly used in the field of "consensus methods for appropriateness studies" of specific health technologies when scientific evidence is lacking or controversial [21,22]. This paper outlines the methodology used to select a set of 10 RDs to be approached in a pilot study to measure socio-economic burden and HRQOL of patients and their caregivers in the EU.…”

The North American Fetal Therapy Network Consensus Statement

“…Early in the first trimester, the number of gestational sacs is equivalent to the number of chorions. 5,8 A thick band of chorion separating two gestational sacs readily identifies a dichorionic gestation. If the gestation is monochorionic diamniotic, it may be challenging to visualize the thin intervening amnion until approximately 8 weeks of gestation.…”

Chorionicity-associated variation in metabolic phenotype of cord blood in twin

“…Twin pregnancies accounted for 0.78% of all births in China in 1989 [ 2 ] but more than doubled to 1.88% from 2007 to 2014 [ 3 ]. Twin pregnancies are associated with a higher incidence of maternal and fetal complications [ 4 , 5 ] compared to singletons. Rates of stillbirth and neonatal mortality for twin gestations are 14.1 and 26.1 per 1000 total births, respectively [ 3 ].…”