Ebook Maternal critical care - A multidisciplinary approach: Part 2
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Ebook Maternal critical care - A multidisciplinary approach: Part 2
Imaging issues in maternal critical careMelina Pcctasides, Filip Claus, and Susanna I. LeeIntroductionRadiological imaging of the critically ill pregn Ebook Maternal critical care - A multidisciplinary approach: Part 2nant woman poses many challenges and constraints unique to this patient population. Correct choice of an imaging examination must take into account not only the clinical scenario but also the potential effects of radiation exposure and intravenous contrast agent administration to both the mother and Ebook Maternal critical care - A multidisciplinary approach: Part 2 the fetus. Unfortunately, the appropriate indications, safety concerns, and diagnostic performance associated with the multitude of radiological studEbook Maternal critical care - A multidisciplinary approach: Part 2
ies represent a knowledge gap for many physicians. Among physicians and the public as a whole, the perception of fetal risk associated with imaging isImaging issues in maternal critical careMelina Pcctasides, Filip Claus, and Susanna I. LeeIntroductionRadiological imaging of the critically ill pregn Ebook Maternal critical care - A multidisciplinary approach: Part 2 risk to the woman and her pregnancy than the hazards of a radiological examination.Close consultation between the clinical team and the radiologist is essential to optimize the choice and performance of the radiological examination. Seamless communication is required to expedite addressing the diag Ebook Maternal critical care - A multidisciplinary approach: Part 2nostic dilemma while minimizing the risk to either the mother or the fetus. This chapter describes the various imaging modalities and the safety conceEbook Maternal critical care - A multidisciplinary approach: Part 2
rns associated with each when used during pregnancy or in the immediate postpartum period. The relative advantages and disadvantages of imaging modaliImaging issues in maternal critical careMelina Pcctasides, Filip Claus, and Susanna I. LeeIntroductionRadiological imaging of the critically ill pregn Ebook Maternal critical care - A multidisciplinary approach: Part 2ects to the fetus arc categorized into deterministic and stochastic effects (Box 22.1). Deterministic effects are non-stochastic, dose related and are seen above a baseline threshold dose. Examplesof deterministic effects include pregnancy loss, growth restriction, mental retardation, and organ malf Ebook Maternal critical care - A multidisciplinary approach: Part 2ormation. In contrast, stochastic effects are possible at any level of radiation exposure with no minimum threshold and with the likelihood increasingEbook Maternal critical care - A multidisciplinary approach: Part 2
with dose. In pregnancy, stochastic effects primarily refer to risk of childhood cancer. The type and severity of deterministic effects and the likelImaging issues in maternal critical careMelina Pcctasides, Filip Claus, and Susanna I. LeeIntroductionRadiological imaging of the critically ill pregn Ebook Maternal critical care - A multidisciplinary approach: Part 2 of Radiologists practice guidelines for imaging pregnant patients, issued in 2010, provided a summary of induced deterministic radiation effects in utcro at various gestational ages and radiation exposures [2]. This summary suggests that risks are unlikely at doses smaller than 100 mGy. At doses ab Ebook Maternal critical care - A multidisciplinary approach: Part 2ove 100 mGy, the risks for deterministic effects such as developmental deficits start to appear but remain low until doses exceed 150-200 mGy. As forEbook Maternal critical care - A multidisciplinary approach: Part 2
stochastic effects, the data are not consistent, but it has been estimated that fetal radiation dose of 100 mGy increases the risk for childhood canceImaging issues in maternal critical careMelina Pcctasides, Filip Claus, and Susanna I. LeeIntroductionRadiological imaging of the critically ill pregn Ebook Maternal critical care - A multidisciplinary approach: Part 2 all diagnostic imaging examinations falls well below clinically negligible doses. Examinations where the fetus is not directly in the radiation beam would administer much less than 1 mGy. When the fetus is directly in the radiation beam, such as pelvic radiography or abdominopelvic CT, the fetus wi Ebook Maternal critical care - A multidisciplinary approach: Part 2ll be exposed to the highest doses but, nevertheless, these are estimated to still fall below the 50 mGy threshold. When outcomes are evaluated, the oEbook Maternal critical care - A multidisciplinary approach: Part 2
ffspring of women exposed to major radiological studies in pregnane)’ do not appear to be at higher risk of childhood malignancy than the children of Imaging issues in maternal critical careMelina Pcctasides, Filip Claus, and Susanna I. LeeIntroductionRadiological imaging of the critically ill pregn Ebook Maternal critical care - A multidisciplinary approach: Part 2hed by Cambridge University Press, ■© Cambridge University Press 2013.Chapter 22: Imaging IssuesBox 22.1. Key points for fetal radiation risk with diagnostic imagingDeterministk effertsPregnancy loss, growth restriction, mental retardation, organ malformationUnlikely at doses <100 mGy [2]Stochastic Ebook Maternal critical care - A multidisciplinary approach: Part 2effects•Childhood cancer dose of 100 mGy increases the risk for childhood cancer by 0.1%; cancer risk with doses <50 mGy is considered negligible [11•Ebook Maternal critical care - A multidisciplinary approach: Part 2
A single diagnostic imaging examination typically administers much less than 50 mGy to the fetusNote: the terms Gray (Gy) and milliGray (mGy) have repImaging issues in maternal critical careMelina Pcctasides, Filip Claus, and Susanna I. LeeIntroductionRadiological imaging of the critically ill pregn Ebook Maternal critical care - A multidisciplinary approach: Part 2 not included in the field of view (e.g. head, neck, chest, and limbs) expose the fetus to scattered radiation only and the dose is negligible:•non-abdominal plain radiographs: negligible•abdominopelvic plain radiograph: well below 50 mGy [ 1 ]•fluoroscopic procedures: more variable and substantial, Ebook Maternal critical care - A multidisciplinary approach: Part 2 unlikely to exceed 100 mGy [5J.Even for plain radiographic studies of the abdomen and pelvis, where the uterus is included in the field of view, theEbook Maternal critical care - A multidisciplinary approach: Part 2
typical fetal dose is estimated at 2-3 mGy [ I J. With fluoroscopic procedures, the fetal dose is more variable and more substantial but is highly unlImaging issues in maternal critical careMelina Pcctasides, Filip Claus, and Susanna I. LeeIntroductionRadiological imaging of the critically ill pregn Ebook Maternal critical care - A multidisciplinary approach: Part 2 evaluating the pregnant patient for abdominopelvic pathologies. It can be performed at the bedside and can reliably evaluate the gallbladder, kidneys, and the urinary bladder, while simultaneously evaluating the gestation. It also detects moderate to large amounts of free intraperitoneal fluid. Bec Ebook Maternal critical care - A multidisciplinary approach: Part 2ause of its limited field of view and low soft tissue contrast, US is less reliable in detecting hepatic, pancreatic, splenic, appendiceal, and adnexaEbook Maternal critical care - A multidisciplinary approach: Part 2
l pathologies, ultrasound evaluates bowelpoorly and is unreliable in detecting abscesses, hematomas, and free air. Consequently, in the context of higImaging issues in maternal critical careMelina Pcctasides, Filip Claus, and Susanna I. LeeIntroductionRadiological imaging of the critically ill pregn Ebook Maternal critical care - A multidisciplinary approach: Part 2eadily available, may allow a faster diagnosis.No biological effects have been documented from diagnostic US examinations in the pregnant patient, despite widespread use over several decades. With Doppler, the risks to the fetus from heat and cavitation exists and, therefore, it should be used judic Ebook Maternal critical care - A multidisciplinary approach: Part 2iously, keeping the exposure time and acoustic output to the lowest level possible |6J.Computed tomographyComputed tomography is fast, reliable, and aEbook Maternal critical care - A multidisciplinary approach: Part 2
ffords a large field of view; consequently, it Is considered the first-line imaging modality for many indications in non-pregnant adults. The fetal raImaging issues in maternal critical careMelina Pcctasides, Filip Claus, and Susanna I. LeeIntroductionRadiological imaging of the critically ill pregn Ebook Maternal critical care - A multidisciplinary approach: Part 2rarely exceeds 50 mGy [7].In pregnancy, the potential effects of fetal radiation exposure should be factored into the risk-benefit analysis when considering ordering an abdomino-pelvic scan:•seek radiological consultation to maintain diagnostic image quality while minimizing fetal dose Ebook Maternal critical care - A multidisciplinary approach: Part 2Imaging issues in maternal critical careMelina Pcctasides, Filip Claus, and Susanna I. LeeIntroductionRadiological imaging of the critically ill pregnGọi ngay
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