ACR Appropriateness Criteria® Multiple Gestations: 2024 Update.

Area of Science:

• Radiology
• Maternal-Fetal Medicine
• Obstetrics

Background:

• The incidence of twin pregnancies is increasing, primarily due to assisted reproductive technologies.
• Ultrasound is essential for determining chorionicity and amnionicity in multiple gestations, predicting risks and guiding follow-up.
• Multiple gestations require more frequent imaging than singleton pregnancies, including dating, nuchal translucency, anatomy, and surveillance scans.

Purpose of the Study:

• To clarify appropriate imaging guidelines for multiple gestations across seven clinical scenarios.
• To provide evidence-based recommendations for initial and follow-up imaging, growth, and surveillance.
• To address uncomplicated and complicated multiple gestations, including those with fetal abnormalities or discordance.

Main Methods:

• Development of evidence-based guidelines using systematic analysis of peer-reviewed literature.
• Adaptation of established methodology principles like Grading of Recommendations Assessment, Development, and Evaluation (GRADE).
• Utilization of the RAND/UCLA Appropriateness Method for determining the suitability of imaging procedures, with expert opinion used when literature is limited.

Main Results:

• The document outlines specific imaging guidelines for various multiple gestation scenarios.
• Recommendations cover initial assessments, ongoing surveillance, and management of complications.
• Guidelines are designed to optimize clinical and imaging follow-up for improved patient outcomes.

Conclusions:

• Appropriate imaging guidelines are critical for managing the increasing number of multiple gestations.
• These evidence-based recommendations aid in risk stratification and clinical decision-making.
• The guidelines support standardized care for multiple pregnancies, ensuring timely and necessary imaging examinations.