Overview of emergency radiological management of the pregnant patient, especially the traumatized pregnant patient

Abstract

Both traumatic and nontraumatic acute emergencies are seen in hospitals in women of childbearing age. The effects of radiation are theoretically most deleterious from 10 days after conception until roughly the end of the first trimester. However, there should be no hesitation about performing appropriate emergency imaging studies at any time during pregnancy. If time permits, the presence and age of the fetus should be determined through physical examination, appropriate laboratory studies, and the obtaining of adequate medical historical information. Imaging studies can be roughly classified into two main categories, those with minimal radiation effect and those that may expose the fetus to significant potential ionizing energy. The radiologist must be responsible for the determination of the most appropriate studies needed and in what sequence. Traumatized pregnant patients especially require maternal and fetal monitoring prior to arrival at the hospital and throughout the hospital stay. Fetal demise is a significant risk in case of both minor and major trauma. Maternal survival is the most significant factor in fetal well-being, with a fetal death approaching 80 % in cases of maternal shock and almost 100 % where there is partial or complete abruptio placentae. Properly performed imaging of the pregnant female, where the uterus is not likely to be exposed to ionizing radiation, should be cause little concern. Depending on the clinical presentation, appropriate first images might include a cervical spine, a portable chest film, an abdominal film, and a lateral decubitus view to check for suspected bowel perforation. This should be rapidly followed by fetal and then maternal ultrasonography. Overall, CT may be the best single abdominal study for severe abdominal problems where multiple organ damage is suspected. MRI for neurological disease and carefully monitored of selective vascular embolization for life-threatening abdominal bleeding are other important legitimate imaging studies.