Transcript General Considerations and Maternal Evaluation

General
Considerations
and Maternal
Evaluation
2003 . 9. 25
Kim min sun
Imaging Techniques




Ionizing Radiation
Ultrasound
Magnetic resonance imaging
Guidelines for diagnostics imaging
during Pregnancy
Ionizing Radiation

Fluoroscopy and Angiography
:Common- upper gastrointestinal series
and barium enema
(Barium enema> UGI series)
: GI endoscopy- commonly used
when a pregnant woman needs
evaluation
: Angiography – performed when the
information obtained alters pregnancy
management
Computed Tomography

Cranial CT(nonenhanced)
- for detection of SDH,SAH,EDH
initial procedure in emergency
situation

CT pelvimetry
- evaluation of maternal pelvic bony
dimension for breech vaginal delivery
Nuclear medicine studies



Ventilation –perfusion lung scan
Thyroid scans
Thallium heart scans
Ultrasound



Very high intencity- human tissue damage
from heat and cavitation
However, low intencity range of real time
imaging- No fetal risks
No contraindication-ultrasound imaging of
maternal organs during pregnancy
Magnetic Resonance Imaging


MRI – useful tool in both OB/GY
imaging
No reported harmful human effects
from its use, including any mutagenic
effects / No demonstrable fetal heart
pattern changes during imaging
Magnetic Resonance Imaging


Indication- Any gestational age if no other
imaging studies can be performed
Contraindication
-Internal cardiac pacemakers
-Neurostimulater
-Implantable cardiac defibrillators
-implantable electronic infusion pumps
-Cochlear implants and some other devices
-Intracranial aneurysm clips
-metallic foreign body in the globe of the
eye
Magnetic Resonance Imaging

Maternal indication
1. Measurements of the pelvic inlet and
midpelvis in the case of breech
presentation
2. Martenal disorder
- brain tumor, spinal trauma
- adrenal tumor (..pheochromocytoma)
- uterine and ovarian mass
Magnetic Resonance Imaging

Fetal indications
-Central nervous system and thoracic
abnormalities
-observation of lecithin peak
(used MRspectroscopy--in vivo analysis of lung maturity
Guidelines for Diagnostic
Imaging during Pregnancy
1.Woman should be counseled that X-ray
exposure from a single diagnostic
procedure dose not result in harmful
fetal effects. Specifically, exposure to
less than 5rad has not been associated
with an increase in fetal anomalies or
pregnancy loss
Guidelines for Diagnostic
Imaging during Pregnancy
2. Concern about possible effects of high-
dose ionizing radiation exposure should
not prevent medically indicated
diagnostic X-ray procedure from being
performed on the mother. During
pregnancy, other imaging procedures not
associated wit ionizing radiation, such as
ultrasonography and magneetic
resonance imaging, should be
considered instead of X-rays when
possible
Guidelines for Diagnostic
Imaging during Pregnancy
3. US and MRI are not associated with
known adverse fetal effects.
However, until more information is
available, MRI is not recommended for
use in the 1st trimester
Guidelines for Diagnostic
Imaging during Pregnancy
4. Consultation with a radiologist may be
helpful in calculating estimated fetal
dose when multiple diagnostic X-rays
are performed on a pregnant woman
Guidelines for Diagnostic
Imaging during Pregnancy
5. The use of radioactive isotope of iodine
is contraindicated for therapeutic use
during pregnancy
Imaging Techniques




Ionizing Radiation
Ultrasound
Magnetic resonance imaging
Guidelines for diagnostics imaging
during Pregnancy
Ionizing Radiation

Fluoroscopy and Angiography
:Common- upper gastrointestinal series
and barium enema
(Barium enema> UGI series)
: GI endoscopy- commonly used
when a pregnant woman needs
evaluation
: Angiography – performed when the
information obtained alters pregnancy
management
Computed Tomography

Cranial CT(nonenhanced)
- for detection of SDH,SAH,EDH
initial procedure in emergency
situation

CT pelvimetry
- evaluation of maternal pelvic bony
dimension for breech vaginal delivery
Nuclear medicine studies



Ventilation –perfusion lung scan
Thyroid scans
Thallium heart scans
Ultrasound



Very high intencity- human tissue damage
from heat and cavitation
However, low intencity range of real time
imaging- No fetal risks
No contraindication-ultrasound imaging of
maternal organs during pregnancy
Magnetic Resonance Imaging


MRI – useful tool in both OB/GY
imaging
No reported harmful human effects
from its use, including any mutagenic
effects / No demonstrable fetal heart
pattern changes during imaging
Magnetic Resonance Imaging


Indication- Any gestational age if no other
imaging studies can be performed
Contraindication
-Internal cardiac pacemakers
-Neurostimulater
-Implantable cardiac defibrillators
-implantable electronic infusion pumps
-Cochlear implants and some other devices
-Intracranial aneurysm clips
-metallic foreign body in the globe of the
eye
Magnetic Resonance Imaging

Maternal indication
1. Measurements of the pelvic inlet and
midpelvis in the case of breech
presentation
2. Martenal disorder
- brain tumor, spinal trauma
- adrenal tumor (..pheochromocytoma)
- uterine and ovarian mass
Magnetic Resonance Imaging

Fetal indications
-Central nervous system and thoracic
abnormalities
-observation of lecithin peak
(used MRspectroscopy--in vivo analysis of lung maturity
Guidelines for Diagnostic
Imaging during Pregnancy
1.Woman should be counseled that X-ray
exposure from a single diagnostic
procedure dose not result in harmful
fetal effects. Specifically, exposure to
less than 5rad has not been associated
with an increase in fetal anomalies or
pregnancy loss
Guidelines for Diagnostic
Imaging during Pregnancy
2. Concern about possible effects of high-
dose ionizing radiation exposure should
not prevent medically indicated
diagnostic X-ray procedure from being
performed on the mother. During
pregnancy, other imaging procedures not
associated wit ionizing radiation, such as
ultrasonography and magneetic
resonance imaging, should be
considered instead of X-rays when
possible
Guidelines for Diagnostic
Imaging during Pregnancy
3. US and MRI are not associated with
known adverse fetal effects.
However, until more information is
available, MRI is not recommended for
use in the 1st trimester
Guidelines for Diagnostic
Imaging during Pregnancy
4. Consultation with a radiologist may be
helpful in calculating estimated fetal
dose when multiple diagnostic X-rays
are performed on a pregnant woman
Guidelines for Diagnostic
Imaging during Pregnancy
5. The use of radioactive isotope of iodine
is contraindicated for therapeutic use
during pregnancy