{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,27]],"date-time":"2026-10-27T09:44:20Z","timestamp":1793094260313,"version":"4.5.0"},"reference-count":35,"publisher":"Elsevier BV","issue":"11","license":[{"start":{"date-parts":[[2025,11,1]],"date-time":"2025-11-01T00:00:00Z","timestamp":1761955200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/www.elsevier.com\/tdm\/userlicense\/1.0\/"},{"start":{"date-parts":[[2025,11,1]],"date-time":"2025-11-01T00:00:00Z","timestamp":1761955200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/www.elsevier.com\/legal\/tdmrep-license"}],"funder":[{"DOI":"10.13039\/100002553","name":"Aid for Cancer Research","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100002553","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100009825","name":"American College of Radiology","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100009825","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100007270","name":"University of Michigan","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100007270","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["clinicalkey.com","clinicalkey.com.au","clinicalkey.es","clinicalkey.fr","clinicalkey.jp","jacr.org","elsevier.com","sciencedirect.com"],"crossmark-restriction":true},"short-container-title":["Journal of the American College of Radiology"],"published-print":{"date-parts":[[2025,11]]},"DOI":"10.1016\/j.jacr.2025.08.043","type":"journal-article","created":{"date-parts":[[2025,11,3]],"date-time":"2025-11-03T23:01:55Z","timestamp":1762210915000},"page":"S531-S538","update-policy":"https:\/\/doi.org\/10.1016\/elsevier_cm_policy","source":"Crossref","is-referenced-by-count":5,"special_numbering":"S","title":["ACR Appropriateness Criteria\u00ae First Trimester Vaginal Bleeding: 2025 Update"],"prefix":"10.1016","volume":"22","author":[{"given":"Sherelle L.","family":"Laifer-Narin","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alana","family":"Fruauff","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cinthia Cruz","family":"Romero","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dorothy I.","family":"Bulas","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ingrid","family":"Burger","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christopher","family":"Fung","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jane","family":"Goldman","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael","family":"Gottlieb","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Priyanka","family":"Jha","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mark A.","family":"Kliewer","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Robin B.","family":"Levenson","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Catherine H.","family":"Phillips","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Liina","family":"Poder","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David","family":"Schultz","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ashish P.","family":"Wasnik","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"78","reference":[{"key":"10.1016\/j.jacr.2025.08.043_bib1","doi-asserted-by":"crossref","first-page":"530","DOI":"10.1002\/uog.20262","article-title":"Early-pregnancy events and subsequent antenatal, delivery and neonatal outcomes: prospective cohort study","volume":"54","author":"Al-Memar","year":"2019","journal-title":"Ultrasound Obstet Gynecol"},{"key":"10.1016\/j.jacr.2025.08.043_bib2","doi-asserted-by":"crossref","first-page":"524","DOI":"10.1016\/j.annepidem.2010.02.006","article-title":"Patterns and predictors of vaginal bleeding in the first trimester of pregnancy","volume":"20","author":"Hasan","year":"2010","journal-title":"Ann Epidemiol"},{"key":"10.1016\/j.jacr.2025.08.043_bib3","doi-asserted-by":"crossref","first-page":"61","DOI":"10.1007\/s10140-017-1556-9","article-title":"First-trimester emergencies: a radiologist\u2019s perspective","volume":"25","author":"Phillips","year":"2018","journal-title":"Emerg Radiol"},{"key":"10.1016\/j.jacr.2025.08.043_bib4","first-page":"1","article-title":"First trimester pregnancy emergencies: recognition and management","volume":"21","author":"Pedigo","year":"2019","journal-title":"Emerg Med Pract"},{"key":"10.1016\/j.jacr.2025.08.043_bib5","doi-asserted-by":"crossref","first-page":"904","DOI":"10.2214\/AJR.13.10644","article-title":"Beyond ultrasound: CT and MRI of ectopic pregnancy","volume":"202","author":"Kao","year":"2014","journal-title":"AJR Am J Roentgenol"},{"key":"10.1016\/j.jacr.2025.08.043_bib6","doi-asserted-by":"crossref","first-page":"325","DOI":"10.2214\/AJR.09.3723","article-title":"CT and MRI of early intrauterine pregnancy","volume":"196","author":"Shin","year":"2011","journal-title":"AJR Am J Roentgenol"},{"key":"10.1016\/j.jacr.2025.08.043_bib8","doi-asserted-by":"crossref","first-page":"781","DOI":"10.1148\/rg.333125177","article-title":"Physiologic, histologic, and imaging features of retained products of conception","volume":"33","author":"Sellmyer","year":"2013","journal-title":"Radiographics"},{"key":"10.1016\/j.jacr.2025.08.043_bib9","doi-asserted-by":"crossref","first-page":"6619","DOI":"10.1007\/s00330-022-08786-4","article-title":"Using MRI to differentiate upper-lateral intracavitary pregnancy and interstitial pregnancy for the patients with pregnancies in the uterotubal junction during the first trimester","volume":"32","author":"Liu","year":"2022","journal-title":"Eur Radiol"},{"key":"10.1016\/j.jacr.2025.08.043_bib10","doi-asserted-by":"crossref","first-page":"952","DOI":"10.1001\/jama.2016.12126","article-title":"Association between MRI exposure during pregnancy and fetal and childhood outcomes","volume":"316","author":"Ray","year":"2016","journal-title":"JAMA"},{"key":"10.1016\/j.jacr.2025.08.043_bib12","doi-asserted-by":"crossref","first-page":"123","DOI":"10.1016\/j.crad.2013.07.021","article-title":"First trimester caesarean scar ectopic pregnancy evaluation using MRI","volume":"69","author":"Peng","year":"2014","journal-title":"Clin Radiol"},{"key":"10.1016\/j.jacr.2025.08.043_bib13","doi-asserted-by":"crossref","first-page":"1104","DOI":"10.1007\/s00261-020-02681-6","article-title":"The many faces of ectopic pregnancies: demystifying the common and less common entities","volume":"46","author":"Ucisik-Keser","year":"2021","journal-title":"Abdom Radiol (NY)"},{"key":"10.1016\/j.jacr.2025.08.043_bib14","doi-asserted-by":"crossref","first-page":"2485","DOI":"10.1016\/j.ejrad.2015.10.005","article-title":"Vascular uterine abnormalities: comparison of imaging findings and clinical outcomes","volume":"84","author":"Hugues","year":"2015","journal-title":"Eur J Radiol"},{"key":"10.1016\/j.jacr.2025.08.043_bib15","first-page":"357","article-title":"A review of the thermal effects during pregnancy by using ultrasound: Doppler mode","volume":"27","author":"Amran","year":"2019","journal-title":"Pertanika J Sci Technol"},{"key":"10.1016\/j.jacr.2025.08.043_bib16","doi-asserted-by":"crossref","first-page":"1020","DOI":"10.1002\/uog.23610","article-title":"ISUOG statement on the safe use of Doppler for fetal ultrasound examination in the first 13 + 6 weeks of pregnancy (updated)","volume":"57","author":"Salvesen","year":"2021","journal-title":"Ultrasound Obstet Gynecol"},{"key":"10.1016\/j.jacr.2025.08.043_bib17","doi-asserted-by":"crossref","first-page":"697","DOI":"10.7863\/ultra.33.4.697","article-title":"Adnexal sonographic findings in ectopic pregnancy and their correlation with tubal rupture and human chorionic gonadotropin levels","volume":"33","author":"Frates","year":"2014","journal-title":"J Ultrasound Med"},{"key":"10.1016\/j.jacr.2025.08.043_bib18","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1016\/j.ajog.2024.07.038","article-title":"A lexicon for first-trimester US: Society of Radiologists in Ultrasound Consensus Conference recommendations","volume":"232","author":"Rodgers","year":"2025","journal-title":"Am J Obstet Gynecol"},{"key":"10.1016\/j.jacr.2025.08.043_bib19","doi-asserted-by":"crossref","first-page":"541","DOI":"10.1002\/jum.15430","article-title":"First-trimester prognosis when an early gestational sac is seen on ultrasound imaging: logistic regression prediction model","volume":"40","author":"Doubilet","year":"2021","journal-title":"J Ultrasound Med"},{"key":"10.1016\/j.jacr.2025.08.043_bib20","doi-asserted-by":"crossref","first-page":"1547","DOI":"10.1002\/jum.15243","article-title":"\u201cPseudogestational sac\u201d and other 1980s-era concepts in early first-trimester ultrasound: are they still relevant today?","volume":"39","author":"Phillips","year":"2020","journal-title":"J Ultrasound Med"},{"key":"10.1016\/j.jacr.2025.08.043_bib21","doi-asserted-by":"crossref","first-page":"65","DOI":"10.1097\/AOG.0b013e318278f421","article-title":"Reevaluation of discriminatory and threshold levels for serum beta-hCG in early pregnancy","volume":"121","author":"Connolly","year":"2013","journal-title":"Obstet Gynecol"},{"key":"10.1016\/j.jacr.2025.08.043_bib22","doi-asserted-by":"crossref","first-page":"1443","DOI":"10.1056\/NEJMra1302417","article-title":"Diagnostic criteria for nonviable pregnancy early in the first trimester","volume":"369","author":"Doubilet","year":"2013","journal-title":"N Engl J Med"},{"key":"10.1016\/j.jacr.2025.08.043_bib23","doi-asserted-by":"crossref","first-page":"465","DOI":"10.7863\/ultra.33.3.465","article-title":"Time to revisit the human chorionic gonadotropin discriminatory level in the management of pregnancy of unknown location","volume":"33","author":"Ko","year":"2014","journal-title":"J Ultrasound Med"},{"key":"10.1016\/j.jacr.2025.08.043_bib24","doi-asserted-by":"crossref","first-page":"1205","DOI":"10.1097\/AOG.0b013e31821568de","article-title":"Perinatal outcomes in women with subchorionic hematoma: a systematic review and meta-analysis","volume":"117","author":"Tuuli","year":"2011","journal-title":"Obstet Gynecol"},{"key":"10.1016\/j.jacr.2025.08.043_bib25","doi-asserted-by":"crossref","first-page":"536","DOI":"10.1002\/uog.20861","article-title":"First-trimester intrauterine hematoma and pregnancy complications","volume":"55","author":"Al-Memar","year":"2020","journal-title":"Ultrasound Obstet Gynecol"},{"key":"10.1016\/j.jacr.2025.08.043_bib26","doi-asserted-by":"crossref","first-page":"178","DOI":"10.14366\/usg.19043","article-title":"Role of ultrasound in the evaluation of first-trimester pregnancies in the acute setting","volume":"39","author":"Murugan","year":"2020","journal-title":"Ultrasonography"},{"key":"10.1016\/j.jacr.2025.08.043_bib27","doi-asserted-by":"crossref","first-page":"276","DOI":"10.1097\/AOG.0000000000003360","article-title":"Association between first-trimester subchorionic hematomas and pregnancy loss in singleton pregnancies","volume":"134","author":"Naert","year":"2019","journal-title":"Obstet Gynecol"},{"key":"10.1016\/j.jacr.2025.08.043_bib28","doi-asserted-by":"crossref","first-page":"170","DOI":"10.17305\/bjbms.2022.7705","article-title":"Impact of subchorionic hematoma on pregnancy outcomes in women with recurrent pregnancy loss","volume":"23","author":"Fu","year":"2023","journal-title":"Biomol Biomed"},{"key":"10.1016\/j.jacr.2025.08.043_bib29","first-page":"639","article-title":"How does subchorionic hematoma in the first trimester affect pregnancy outcomes?","volume":"18","author":"Gunay","year":"2022","journal-title":"Arch Med Sci"},{"key":"10.1016\/j.jacr.2025.08.043_bib30","doi-asserted-by":"crossref","first-page":"2835","DOI":"10.1002\/jum.15971","article-title":"Fourfold improved odds of a good first trimester outcome once a yolk sac is seen in early pregnancy","volume":"41","author":"Doubilet","year":"2022","journal-title":"J Ultrasound Med"},{"key":"10.1016\/j.jacr.2025.08.043_bib31","first-page":"166","article-title":"First trimester bleeding: evaluation and management","volume":"99","author":"Hendriks","year":"2019","journal-title":"Am Fam Physician"},{"key":"10.1016\/j.jacr.2025.08.043_bib32","article-title":"Defining safe criteria to diagnose miscarriage: prospective observational multicentre study","volume":"351","author":"Preisler","year":"2015","journal-title":"BMJ"},{"key":"10.1016\/j.jacr.2025.08.043_bib33","doi-asserted-by":"crossref","first-page":"e197","DOI":"10.1097\/AOG.0000000000002899","article-title":"ACOG Practice Bulletin No. 200: early pregnancy loss","volume":"132","year":"2018","journal-title":"Obstet Gynecol"},{"key":"10.1016\/j.jacr.2025.08.043_bib34","doi-asserted-by":"crossref","first-page":"2031","DOI":"10.7863\/ultra.33.11.2031","article-title":"Three-dimensional sonography in the differential diagnosis of interstitial, angular, and intrauterine pregnancies in a septate uterus","volume":"33","author":"Tanaka","year":"2014","journal-title":"J Ultrasound Med"},{"key":"10.1016\/j.jacr.2025.08.043_bib35","doi-asserted-by":"crossref","first-page":"100","DOI":"10.1002\/uog.16216","article-title":"Natural history of Cesarean scar pregnancy on prenatal ultrasound: the crossover sign","volume":"50","author":"Cali","year":"2017","journal-title":"Ultrasound Obstet Gynecol"},{"key":"10.1016\/j.jacr.2025.08.043_bib36","doi-asserted-by":"crossref","first-page":"72","DOI":"10.1002\/jcu.22410","article-title":"Sonographic diagnosis of partial versus complete molar pregnancy: a reappraisal","volume":"45","author":"Savage","year":"2017","journal-title":"J Clin Ultrasound"},{"key":"10.1016\/j.jacr.2025.08.043_bib40","series-title":"Measuring sex, gender identity, and sexual orientation","article-title":"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","year":"2022"}],"container-title":["Journal of the American College of Radiology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/api.elsevier.com\/content\/article\/PII:S1546144025004971?httpAccept=text\/xml","content-type":"text\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/api.elsevier.com\/content\/article\/PII:S1546144025004971?httpAccept=text\/plain","content-type":"text\/plain","content-version":"vor","intended-application":"text-mining"}],"deposited":{"date-parts":[[2026,2,25]],"date-time":"2026-02-25T16:17:00Z","timestamp":1772036220000},"score":1,"resource":{"primary":{"URL":"https:\/\/linkinghub.elsevier.com\/retrieve\/pii\/S1546144025004971"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,11]]},"references-count":35,"journal-issue":{"issue":"11","published-print":{"date-parts":[[2025,11]]}},"alternative-id":["S1546144025004971"],"URL":"https:\/\/doi.org\/10.1016\/j.jacr.2025.08.043","relation":{},"ISSN":["1546-1440"],"issn-type":[{"value":"1546-1440","type":"print"}],"subject":[],"published":{"date-parts":[[2025,11]]},"assertion":[{"value":"Elsevier","name":"publisher","label":"This article is maintained by"},{"value":"ACR Appropriateness Criteria\u00ae First Trimester Vaginal Bleeding: 2025 Update","name":"articletitle","label":"Article Title"},{"value":"Journal of the American College of Radiology","name":"journaltitle","label":"Journal Title"},{"value":"https:\/\/doi.org\/10.1016\/j.jacr.2025.08.043","name":"articlelink","label":"CrossRef DOI link to publisher maintained version"},{"value":"article","name":"content_type","label":"Content Type"},{"value":"\u00a9 2025 American College of Radiology. Published by Elsevier Inc. All rights are reserved, including those for text and data mining, AI training, and similar technologies.","name":"copyright","label":"Copyright"}]}}