Multimodality imaging of acute non-obstetric maternal complications

Congress:

ECR 2020

Poster Number:

C-08291

Type:

Educational Exhibit

Keywords:

Performed at one institution, Not applicable, Retrospective, Obstetrics, Acute, Complications, MR, CT, Obstetrics (Pregnancy / birth / postnatal period), Emergency, Emergency Imaging

Authors:

R. J. Gravell¹, H. Edwards², J. Taylor², D. M. Paravasthu²; ¹Warrington /UK, ²Warrington/UK

DOI:

10.26044/ecr2020/C-08291

DOI-Link:

https://dx.doi.org/10.26044/ecr2020/C-08291

Table 1: patient demographics and corresponding diagnoses

Fig. 1: Coronal CT image showing appendicitis with appendicolith (red arrow) in patient...

Fig. 3: Coronal CT demonstrating small bowel obstruction in patient at 23/40 weeks. ...

Fig. 5: Coronal CT image demonstrating red cell degeneration in patient in the...

Fig. 6: Axial T2 weighted MRI image of red cell degeneration in patient in post-natal...

Fig. 9: Axial CT slice demonstrating ovarian hyperstimulation during the post-natal...

Fig. 11: Sagittal CT demonstrating a large bladder flap haematoma (red arrow) post...

Fig. 12: Coronal CT demonstrating filing defect (red arrow) in right inferior pulmonary...

Learning objectives

We aim to present a review of acute non-obstetric pathologies in pregnant and early postpartum women presenting to radiological services to highlight the differentials radiologists can expect to see when reviewing imaging in this cohort.

Background

Evaluating non-obstetric medical conditions during pregnancy remains diagnostically challenging.The literature suggests a suboptimal understanding amongst physicians regarding dosimetry and extent of radiation risks to this subgroup (Patelet al, 2007) despite millions of women undergoing pregnancy every year (Sedghet al, 2012). Ionising radiation, both a carcinogen (Shuzet al,2017) and teratogen, pose risks to the highly radiosensitive foetus (Valentin, 2003). Good quality research into safety isdifficult due to the ethical implications but dose exposure remainsunder constant review (Dol & Wakeford, 2014; Valentin, 2003).Notwithstanding, radiologists need the expertise...

Findings and procedure details

We reviewed the results of all imaging modalities carried out on obstetric patients over a five-year period (2015 – 2019).We searched the image database with the words: pregnant, pregnancy, antenatal, ante natal, postpartum, post partum and post-partum. 45 cases were reviewed of which 12 met inclusion criteria.A breakdown of these can be seen in Table 1 . The imaging findings were reviewed highlightinglearning points and pitfalls in diagnosis. Diagnoses were mainly gastrointestinal, urinary and gynaecological in nature.This delineates the range of differential diagnosis clinicians face...

Conclusion

The imaging of women during and shortly after pregnancy has an important role in order to diagnose complex pathologies that could affect the mother and/or foetus. This review highlights a variety of acute non-obstetric cases that may present to the radiological service.It is important to improve both our awareness of such cases and knowledge of how best to image the patient considering radiation safety for both mother and foetus.

Personal information and conflict of interest

R. J. Gravell; Warrington/UK - nothing to disclose D. M. Paravasthu; Warrington/UK - nothing to disclose J. Taylor; Warrington/UK - nothing to disclose H. Edwards; Warrington/UK - nothing to disclose

References

Augustin, G., et al.2007.Non-obstetric acute abdomen during pregnancy.European journal of Obstetrics and Gynaecology and Reproductive Biology,131(1), pp.4 – 12. Dol, R., & Wakeford, R. 2014.Risk of childhood cancer from fetal irradiation.British Journal of radiology,70, pp. 130 – 139. Kumar, P.,et al.2011.Ovarian hyperstimulation syndrome.Journal of human reproductive science,4(2), pp.70 – 75. Lee, H, J., et al.2010.Contemporary Management of fibroids in pregnancy.Obstetrics and Gynaecology,3(1), pp.20 – 27. Leung, A, N., et al.2012.American thoracic society documents:AN official American thoracic society/society of thoracic radiology clinical practice guideline evaluation of...