Imaging Pregnant Patients in Different Acute Medical Non-Traumatic Emergencies. A Literature Review.
AJTES Vol 4; No 1; January 2020
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non-traumatic emergencies

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Tocilla, B. (2020). Imaging Pregnant Patients in Different Acute Medical Non-Traumatic Emergencies. A Literature Review. Albanian Journal of Trauma and Emergency Surgery, 4(1), 589-602.


Radiologists should suggest what kind of imaging is best suited for a pregnant patient presenting with an acute condition. The type of imaging study is planned in close consultation with the clinical team. Ultrasonography (US) should always be the initial modality for evaluation of a pregnant patient, especially in abdominal emergencies. In other conditions like suspected pulmonary embolism or neurological emergencies ultrasound doesn’t help, so using other diagnostic modalities like CT and MRI will be necessary. A recurring debate in many radiology practices is the concern of radiologists about performing an examination that exposes a fetus to radiation. This literature review aims to identify an optimal imaging strategy for the accurate detection of different acute medical non-traumatic emergencies in pregnant patients.
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1. Coakley FV, Glenn OA, Qayyum A, Barkovich AJ, Goldstein R, Filly RA. Fetal MRI: a developing technique for the developing patient. AJR Am J Roentgenol 2004;182(1):243–252.
2. Wagner LK, Lester RG, Saldana LR. Exposure of the pregnant patient to diagnostic radiations: a guide to medical management. 2nd ed. Madison, Wis: Medical Physics, 1997.
3. Brent RL. Saving lives and changing family histories: appropriate counseling of pregnant women and men and women of reproductive age, concerning the risk of diagnostic radiation exposures during and before pregnancy. Am J Obstet Gynecol 2009;200(1): 4–24.
4. Bushberg JT. The essential physics of medical imag¬ing. 2nd ed. Philadelphia, Pa: Lippincott Williams & Wilkins, 2002.
5. Wieseler KM1, Bhargava P, Kanal KM, Vaidya S, Stewart BK, Dighe MK. Imaging in pregnant patients: examination appropriateness.Radiographics. 2010 Sep;30(5):1215-29; discussion 1230-3. doi: 10.1148/rg.305105034.
6. American College of Radiology. ACR practice guideline for imaging pregnant or potentially preg¬nant adolescents and women with ionizing radiation. Reston, Va: American College of Radiology, 2008
7. Patel SJ, Reede DL, Katz DS, Subramaniam R, Amorosa JK. Imaging the pregnant patient for nonobstetric conditions: algorithms and radiation dose considerations. RadioGraphics 2007;27(6): 1705–1722.
8. Martin JN Jr, Ridgway LE 3rd, Connors JJ, Sessums JK, Martin RW, Morrison JC. Angiographic arterial embolization and computed tomography-directed drainage for the management of hemorrhage and in¬fection with abdominal pregnancy. Obstet Gynecol 1990;76(5 pt 2):941–945.
9. Bushberg JT. X-ray interactions. RadioGraphics 1998;18(2):457–468.
10. Toglia MR, Weg JG. Venous thromboembolism during pregnancy. N Engl J Med 1996; 335:108–114.
11. Knight M. Antenatal pulmonary embolism: risk factors, management and outcomes. BJOG 2008; 115:453–461.
12. Winer-Muram HT, Boone JM, Brown HL, Jennings SG, Mabie WC, Lombardo GT. Pulmonary embolism in pregnant patients: fetal radiation dose with helical CT. Radiology 2002;224:487–492.
13. British Thoracic Society Standards of Care Committee Pulmonary Embolism Guideline Development Group. British Thoracic Society guidelines for the management of suspected acute pulmonary embolism. Thorax 2003; 58:470–483.
14. Schuster ME, Fishman JE, Copeland JF, Hatabu H, Boiselle PM. Pulmonary embolism in pregnant patients: a survey of practices and policies for CT pulmonary angiography. AJR Am J Roentgenol 2003; 181:1495–1498.
15. Stein PD, Woodard PK, Weg JG, et al. Diagnostic pathways in acute pulmonary embolism: recommendations of the PIOPED II investigators. Radiology 2007; 242:15–21.
16. Pahade JK1, Litmanovich D, Pedrosa I, Romero J, Bankier AA, Boiselle PM. Radiographics. Quality initiatives: imaging pregnant patients with suspected pulmonary embolism: what the radiologist needs to know.2009 May-Jun;29(3):639-54. doi: 10.1148/rg.293085226. Epub 2009 Mar 30.
17. Leung AN, Bull TM, Jaeschke R, Lockwood CJ, Boiselle PM, Hurwitz LM, James AH, McCullough LB, Menda Y, Paidas MJ, Royal HD, Tapson VF, Winer-Muram HT, Chervenak FA, Cody DD, McNitt-Gray MF, Stave CD, Tuttle BD; ATS/STR Committee on Pulmonary Embolism in Pregnancy. An official American Thoracic Society/Society of Thoracic Radiology clinical practice guideline: evaluation of suspected pulmonary embolism in pregnancy. Am J Respir Crit Care Med. 2011 Nov 15;184(10):1200-8. doi: 10.1164/rccm.201108-1575ST.
18. Parker MS, Hui FK, Camacho MA, Chung JK, Broga DW, Sethi NN. Female breast radiation exposure during CT pulmonary angiography. AJR Am J Roentgenol 2005; 185:1228–1233.
19. Rehani MM, Berry M. Radiation doses in computed tomography: the increasing doses of radiation need to be controlled. BMJ 2000; 320:593–594.
20. Nickoloff EL, Alderson PO. Radiation exposures to patients from CT: reality, public perception, and policy. AJR Am J Roentgenol 2001; 177:285–287
21. Andersen B, Nielsen TF. Appendicitis in pregnancy: diagnosis, management and complications. Acta Obstet Gynecol Scand 1999;78(9):758–762.
22. Cappell MS, Friedel D. Abdominal pain during pregnancy. Gastroenterol Clin North Am 2003;32 (1):1–58.
23. Wieseler KM, Bhargava P, Kanal KM, Vaidya S, Stewart BK, Dighe MK. Imaging in pregnant patients: examination appropriateness. Radiographics. 2010;30(5):1215-1229; discussion 1230-1213.
24. Masselli G, Derme M, Laghi F, et al. Imaging of stone disease in pregnancy. Abdom Imaging. 013;38(6):1409-1414.
25. McAleer SJ, Loughlin KR. Nephrolithiasis and pregnancy. Curr Opin Urol. 2004;14(2):123-127.
26. Rasmussen PE, Nielsen FR. Hydronephrosis during pregnancy: a literature survey. Eur J Obstet Gynecol Reprod Biol. 1988;27(3):249-259.
27. Nelson JA, Livingston JC, Moon RG. Mutagenic evaluation of radiographic contrast media. Invest Radiol 1982; 17: 183-185.
28. Morisetti A, Tirone P, Luzzani F, de Haen C. Toxicologic safety assessment of iomeprol, a new x-ray contrast agent. Eur J Radiol 1994; 18 (Suppl 1): 21-31.
29. Ralston WH, Robbins MS, James P. Reproductive, developmental, and genetic toxicity of ioversol. Invest Radiol 1989; 24 (Suppl 1): 16-22.
30. Desch F, Camus M, Ermans AM, et al. Adverse effects of amniofetography on fetal thyroid function. Am J Obstet Gynecol 1976; 126: 723-726.
31. Na G, Zaffaroni M, Defilippi C, et al. Effects of iopamidol on neonatal thyroid function. Eur J Radiol 1992; 12: 22-25.
32. Webb JA, Thomsen HS, Morcos SK; Members of Contrast Media Safety Committee of European Society of Urogenital Radiology (ESUR). The use of iodinated and gadolinium contrast media during pregnancy and lactation. Eur Radiol 2005; 15: 1234-1240.
33. Okuda Y, Sagami F, Tirone P, Morisetti A, Bussi S, Masters RE. Reproductive and developmental toxicity study of gadobenate dimeglumine formulation (E7155) (3) --Study of embryo-fetal toxicity in rabbits by intravenous administration. J Toxicol Sci 1999;24 (Suppl 1): 79-87.
34. Marcos HB, Semelka RC, Worawattanakul S. Normal placenta: gadolinium-enhanced dynamic MR imaging. Radiology. 1997; 205: 493-6.
35. Spencer JA, Tomlinson AJ, Weston MJ, Lloyd SN. Early report: comparison of breath-hold MR excretory urography, Doppler ultrasound and isotope renography in evaluation of symptomatic hydronephrosis in pregnancy. Clin Radiol. 2000;55: 446-53.
36. Kanal E, Barkovich AJ, Bell C, Borgstede JP, Bradley WG, Jr., Froelich JW, et al. ACR guidance document for safe MR practices: 2007. AJR Am J Roentgenol 2007; 188: 1447-74.
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