General Considerations and Maternal Evaluation

1
General Considerations and Maternal Evaluation

• 2003 . 9. 25 Kim min sun

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Imaging Techniques

• Ionizing Radiation
• Ultrasound
• Magnetic resonance imaging
• Guidelines for diagnostics imaging during
  Pregnancy

3
Ionizing Radiation

• Fluoroscopy and Angiography
• Common- upper gastrointestinal series and
  barium enema
• (Barium enemagt UGI series)
• GI endoscopy- commonly used
• when a pregnant woman needs
• evaluation
• Angiography performed when the
  information obtained alters pregnancy management
  

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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

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Nuclear medicine studies

• Ventilation perfusion lung scan
• Thyroid scans
• Thallium heart scans

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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

10
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

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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

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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

13
Magnetic Resonance Imaging

• Fetal indications
• -Central nervous system and thoracic
  abnormalities
• -observation of lecithin peak
• (used MRspectroscopy---
• in vivo analysis of lung maturity

14
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

15
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

16
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

17
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

18
Guidelines for Diagnostic Imaging during Pregnancy

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

19
Imaging Techniques

• Ionizing Radiation
• Ultrasound
• Magnetic resonance imaging
• Guidelines for diagnostics imaging during
  Pregnancy

20
Ionizing Radiation

• Fluoroscopy and Angiography
• Common- upper gastrointestinal series and
  barium enema
• (Barium enemagt UGI series)
• GI endoscopy- commonly used
• when a pregnant woman needs
• evaluation
• Angiography performed when the
  information obtained alters pregnancy management
  

21
(No Transcript)
22
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

23
(No Transcript)
24
Nuclear medicine studies

• Ventilation perfusion lung scan
• Thyroid scans
• Thallium heart scans

25
(No Transcript)
26
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

27
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

28
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

29
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

30
Magnetic Resonance Imaging

• Fetal indications
• -Central nervous system and thoracic
  abnormalities
• -observation of lecithin peak
• (used MRspectroscopy---
• in vivo analysis of lung maturity

31
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

32
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

33
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

34
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

35
Guidelines for Diagnostic Imaging during Pregnancy

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

36
(No Transcript)