Book of Medical Disorders in Pregnancy - Tintash

MRI) it is advisable to explain the
negligible nature of the risk to the
patient and document this discussion in
either the chart or the radiology report.
Fig16.5: Shows pelvimetry with baby
done for pelvic disproportion
Specific points:
The most common indications for urgent
CT during pregnancy are:
Appendicitis - For first and second trimester
pregnancies US and/or MR should
be performed prior to obtaining a CT
Pulmonary embolism - In this case a CT
pulmonary angiogram exposes the fetus
to less radiation than a VQ scan. Therefore,
CT should be the initial modality.
Renal colic - US is the initial study of
choice. Trauma. US may be sufficient
for the initial imaging evaluation of a
pregnant patient who has sustained
trauma, but CT should be performed if
serious injury is suspected.
All patients undergoing CT of the
abdomen or pelvis during pregnancy
should sign the written informed consent
form the consent form can be completed
by either the referring physician or the
involved radiologist (including the
radiology resident on call). Patients
referred from the Department of Obstetrics,
Gynecology and Reproductive
226
Sciences will be consented by the referring
physician.
For studies that pose minimal risk
(including CT pelvimetry, CT of other
body parts, and MRI) it is advisable to
explain the negligible nature of the risk
to the patient and document this
discussion in either the chart or the
radiology report.
This discussion can be undertaken by
either the referring physician or the
involved radiologist.
CT contrast seems safe to use in pregnancy
and should be administered in
the usual fashion in this is far preferable
to repeating a study because the initial
examination was non-diagnostic due to
lack of intravenous contrast.
Intravenous gadolinium is
contraindicated in pregnancy, and should
only be used if absolutely essential and
only after discussion of risks and
benefits with the patient and referring
clinician and radiology faculty.
Pelvimetry can be performed either by
low dose CT or by MRI, and written
informed consent is not required.
Fig16.6: Shows pelvic CT scan
without fetus