General General Considerations Considerations and Maternal and Maternal

EvaluationEvaluation

2003 . 9. 25 2003 . 9. 25 Kim min sunKim min sun

Imaging TechniquesImaging Techniques

Ionizing RadiationIonizing Radiation UltrasoundUltrasound Magnetic resonance imagingMagnetic resonance imaging Guidelines for diagnostics imaging Guidelines for diagnostics imaging

during Pregnancyduring Pregnancy

Ionizing RadiationIonizing Radiation Fluoroscopy and AngiographyFluoroscopy and Angiography :Common- upper gastrointestinal series and ba:Common- upper gastrointestinal series and ba

rium enemarium enema (Barium enema> UGI series)(Barium enema> UGI series) : GI endoscopy- commonly used: GI endoscopy- commonly used when a pregnant woman needs when a pregnant woman needs evaluationevaluation : Angiography – performed when the informatio: Angiography – performed when the informatio

n obtained alters pregnancy management n obtained alters pregnancy management

Computed TomographyComputed Tomography

Cranial CT(nonenhanced)Cranial CT(nonenhanced) - for detection of SDH,SAH,EDH- for detection of SDH,SAH,EDH initial procedure in emergency situatioinitial procedure in emergency situatio

nn

CT pelvimetryCT pelvimetry - evaluation of maternal pelvic bony dim- evaluation of maternal pelvic bony dim

ension for breech vaginal deliveryension for breech vaginal delivery

Nuclear medicine studiesNuclear medicine studies

Ventilation –perfusion lung scanVentilation –perfusion lung scan Thyroid scansThyroid scans Thallium heart scansThallium heart scans

UltrasoundUltrasound Very high intencity- human tissue damage from hVery high intencity- human tissue damage from h

eat and cavitation eat and cavitation However, However, low intencity range of real time imaginglow intencity range of real time imaging

- No fetal risks- No fetal risks

No contraindication-ultrasound imaging of maternNo contraindication-ultrasound imaging of maternal organs during pregnancyal organs during pregnancy

Magnetic Resonance Magnetic Resonance ImagingImaging

MRI – useful tool in both OB/GY MRI – useful tool in both OB/GY imagingimaging

No reported harmful human effects No reported harmful human effects from its use, including any mutagenic from its use, including any mutagenic effects / No demonstrable fetal heart effects / No demonstrable fetal heart pattern changes during imagingpattern changes during imaging

Magnetic Resonance Magnetic Resonance ImagingImaging

Indication- Any gestational age if no other imaging stuIndication- Any gestational age if no other imaging studies can be performeddies can be performed

Contraindication Contraindication -Internal cardiac pacemakers-Internal cardiac pacemakers -Neurostimulater-Neurostimulater -Implantable cardiac defibrillators-Implantable cardiac defibrillators -implantable electronic infusion pumps-implantable electronic infusion pumps -Cochlear implants and some other devices-Cochlear implants and some other devices -Intracranial aneurysm clips-Intracranial aneurysm clips -metallic foreign body in the globe of the eye -metallic foreign body in the globe of the eye

Magnetic Resonance Magnetic Resonance ImagingImaging

Maternal indicationMaternal indication 1. Measurements of the pelvic inlet and midpe1. Measurements of the pelvic inlet and midpe

lvis in the case of breech presentationlvis in the case of breech presentation 2. Martenal disorder2. Martenal disorder - brain tumor, spinal trauma- brain tumor, spinal trauma - adrenal tumor (..pheochromocytoma)- adrenal tumor (..pheochromocytoma) - uterine and ovarian mass- uterine and ovarian mass

Magnetic Resonance Magnetic Resonance ImagingImaging

Fetal indicationsFetal indications -Central nervous system and thoracic abno-Central nervous system and thoracic abno

rmalitiesrmalities -observation of lecithin peak-observation of lecithin peak (used MRspectroscopy---(used MRspectroscopy--- in vivo analysis of lung maturityin vivo analysis of lung maturity

Guidelines for Diagnostic Guidelines for Diagnostic Imaging during Imaging during

PregnancyPregnancy1.Woman should be counseled that X-1.Woman should be counseled that X-

ray exposure from ray exposure from a single a single diagnostic procedure dose not diagnostic procedure dose not result in harmful fetal effects.result in harmful fetal effects. Specifically, exposure to less than Specifically, exposure to less than 5rad has not been associated with an 5rad has not been associated with an increase in fetal anomalies or increase in fetal anomalies or pregnancy losspregnancy loss

Guidelines for Diagnostic Guidelines for Diagnostic Imaging during Imaging during

PregnancyPregnancy2. 2. Concern about possible effects of high-dosConcern about possible effects of high-dos

e ionizing radiation exposure should e ionizing radiation exposure should not prenot prevent medically indicated diagnostic X-ray provent medically indicated diagnostic X-ray procedure from being performed on the mother.cedure from being performed on the mother. During pregnancy, other imaging procedures During pregnancy, other imaging procedures not associated wit ionizing radiation, such anot associated wit ionizing radiation, such as s ultrasonography and magneetic resonance ultrasonography and magneetic resonance imagingimaging, should be considered instead of X-, should be considered instead of X-rays when possiblerays when possible

Guidelines for Diagnostic Guidelines for Diagnostic Imaging during Imaging during

PregnancyPregnancy

3. 3. US and MRI are not associated US and MRI are not associated with known adverse fetal with known adverse fetal effects.effects.

However, until more information is However, until more information is available, available, MRI is not MRI is not recommended for use in the 1recommended for use in the 1stst trimester trimester

Guidelines for Diagnostic Guidelines for Diagnostic Imaging during Imaging during

PregnancyPregnancy

4. Consultation with a radiologist may 4. Consultation with a radiologist may be helpful in be helpful in calculating estimated calculating estimated fetal dose when multiple fetal dose when multiple diagnostic X-raysdiagnostic X-rays are performed on are performed on a pregnant womana pregnant woman

Guidelines for Diagnostic Guidelines for Diagnostic Imaging during Imaging during

PregnancyPregnancy

5. The use of 5. The use of radioactive isotope of radioactive isotope of iodine is contraindicatediodine is contraindicated for for therapeutic use during pregnancytherapeutic use during pregnancy

Imaging TechniquesImaging Techniques

Ionizing RadiationIonizing Radiation UltrasoundUltrasound Magnetic resonance imagingMagnetic resonance imaging Guidelines for diagnostics imaging Guidelines for diagnostics imaging

during Pregnancyduring Pregnancy

Ionizing RadiationIonizing Radiation Fluoroscopy and AngiographyFluoroscopy and Angiography :Common- upper gastrointestinal series and ba:Common- upper gastrointestinal series and ba

rium enemarium enema (Barium enema> UGI series)(Barium enema> UGI series) : GI endoscopy- commonly used: GI endoscopy- commonly used when a pregnant woman needs when a pregnant woman needs evaluationevaluation : Angiography – performed when the informatio: Angiography – performed when the informatio

n obtained alters pregnancy management n obtained alters pregnancy management

Computed TomographyComputed Tomography

Cranial CT(nonenhanced)Cranial CT(nonenhanced) - for detection of SDH,SAH,EDH- for detection of SDH,SAH,EDH initial procedure in emergency situatioinitial procedure in emergency situatio

nn

CT pelvimetryCT pelvimetry - evaluation of maternal pelvic bony dim- evaluation of maternal pelvic bony dim

ension for breech vaginal deliveryension for breech vaginal delivery

Nuclear medicine studiesNuclear medicine studies

Ventilation –perfusion lung scanVentilation –perfusion lung scan Thyroid scansThyroid scans Thallium heart scansThallium heart scans

UltrasoundUltrasound Very high intencity- human tissue damage from hVery high intencity- human tissue damage from h

eat and cavitation eat and cavitation However, However, low intencity range of real time imaginglow intencity range of real time imaging

- No fetal risks- No fetal risks

No contraindication-ultrasound imaging of maternNo contraindication-ultrasound imaging of maternal organs during pregnancyal organs during pregnancy

Magnetic Resonance Magnetic Resonance ImagingImaging

MRI – useful tool in both OB/GY MRI – useful tool in both OB/GY imagingimaging

No reported harmful human effects No reported harmful human effects from its use, including any mutagenic from its use, including any mutagenic effects / No demonstrable fetal heart effects / No demonstrable fetal heart pattern changes during imagingpattern changes during imaging

Magnetic Resonance Magnetic Resonance ImagingImaging

Indication- Any gestational age if no other imaging stuIndication- Any gestational age if no other imaging studies can be performeddies can be performed

Contraindication Contraindication -Internal cardiac pacemakers-Internal cardiac pacemakers -Neurostimulater-Neurostimulater -Implantable cardiac defibrillators-Implantable cardiac defibrillators -implantable electronic infusion pumps-implantable electronic infusion pumps -Cochlear implants and some other devices-Cochlear implants and some other devices -Intracranial aneurysm clips-Intracranial aneurysm clips -metallic foreign body in the globe of the eye -metallic foreign body in the globe of the eye

Magnetic Resonance Magnetic Resonance ImagingImaging

Maternal indicationMaternal indication 1. Measurements of the pelvic inlet and midpe1. Measurements of the pelvic inlet and midpe

lvis in the case of breech presentationlvis in the case of breech presentation 2. Martenal disorder2. Martenal disorder - brain tumor, spinal trauma- brain tumor, spinal trauma - adrenal tumor (..pheochromocytoma)- adrenal tumor (..pheochromocytoma) - uterine and ovarian mass- uterine and ovarian mass

Magnetic Resonance Magnetic Resonance ImagingImaging

Fetal indicationsFetal indications -Central nervous system and thoracic abno-Central nervous system and thoracic abno

rmalitiesrmalities -observation of lecithin peak-observation of lecithin peak (used MRspectroscopy---(used MRspectroscopy--- in vivo analysis of lung maturityin vivo analysis of lung maturity

Guidelines for Diagnostic Guidelines for Diagnostic Imaging during Imaging during

PregnancyPregnancy1.Woman should be counseled that X-1.Woman should be counseled that X-

ray exposure from ray exposure from a single a single diagnostic procedure dose not diagnostic procedure dose not result in harmful fetal effects.result in harmful fetal effects. Specifically, exposure to less than Specifically, exposure to less than 5rad has not been associated with an 5rad has not been associated with an increase in fetal anomalies or increase in fetal anomalies or pregnancy losspregnancy loss

Guidelines for Diagnostic Guidelines for Diagnostic Imaging during Imaging during

PregnancyPregnancy2. 2. Concern about possible effects of high-dosConcern about possible effects of high-dos

e ionizing radiation exposure should e ionizing radiation exposure should not prenot prevent medically indicated diagnostic X-ray provent medically indicated diagnostic X-ray procedure from being performed on the mother.cedure from being performed on the mother. During pregnancy, other imaging procedures During pregnancy, other imaging procedures not associated wit ionizing radiation, such anot associated wit ionizing radiation, such as s ultrasonography and magneetic resonance ultrasonography and magneetic resonance imagingimaging, should be considered instead of X-, should be considered instead of X-rays when possiblerays when possible

Guidelines for Diagnostic Guidelines for Diagnostic Imaging during Imaging during

PregnancyPregnancy

3. 3. US and MRI are not associated US and MRI are not associated with known adverse fetal with known adverse fetal effects.effects.

However, until more information is However, until more information is available, available, MRI is not MRI is not recommended for use in the 1recommended for use in the 1stst trimester trimester

Guidelines for Diagnostic Guidelines for Diagnostic Imaging during Imaging during

PregnancyPregnancy

4. Consultation with a radiologist may 4. Consultation with a radiologist may be helpful in be helpful in calculating estimated calculating estimated fetal dose when multiple fetal dose when multiple diagnostic X-raysdiagnostic X-rays are performed on are performed on a pregnant womana pregnant woman

Guidelines for Diagnostic Guidelines for Diagnostic Imaging during Imaging during

PregnancyPregnancy

5. The use of 5. The use of radioactive isotope of radioactive isotope of iodine is contraindicatediodine is contraindicated for for therapeutic use during pregnancytherapeutic use during pregnancy