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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

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General Considerations and Maternal Evaluation

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  1. General Considerations and Maternal Evaluation 2003 . 9. 25 Kim min sun

  2. 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 enema> UGI series) : GI endoscopy- commonly used when a pregnant woman needs evaluation : Angiography – performed when the information obtained alters pregnancy management

  4. 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

  5. Nuclear medicine studies • Ventilation –perfusion lung scan • Thyroid scans • Thallium heart scans

  6. 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

  7. 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

  8. 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

  9. 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

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

  11. 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

  12. 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

  13. 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

  14. 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

  15. Guidelines for Diagnostic Imaging during Pregnancy 5. The use of radioactive isotope of iodine is contraindicated for therapeutic use during pregnancy

  16. Imaging Techniques • Ionizing Radiation • Ultrasound • Magnetic resonance imaging • Guidelines for diagnostics imaging during Pregnancy

  17. 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

  18. 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

  19. Nuclear medicine studies • Ventilation –perfusion lung scan • Thyroid scans • Thallium heart scans

  20. 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

  21. 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

  22. 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

  23. 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

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

  25. 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

  26. 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

  27. 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

  28. 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

  29. Guidelines for Diagnostic Imaging during Pregnancy 5. The use of radioactive isotope of iodine is contraindicated for therapeutic use during pregnancy

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