A review of the current use of magnetic resonance imaging in pregnancy and safety implications for the fetus

Wilde, Janet P. De; Rivers, A.; Price, David L.

doi:10.1016/j.pbiomolbio.2004.08.010

Cited by 303 publications

(177 citation statements)

References 115 publications

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“…Visual field testing and MRI scanning should be carried out only in patients who develop symptoms and when intervention may be indicated. There are no data documenting harm to the developing fetus from either MRI scans or gadolinium (64,65,66,67); nonetheless, the ideal time to perfom an MRI and the use of gadolinum during pregnancy are still the matters of debate among radiologists. However, in the face of symptoms of headaches that may be nonspecific, it is important to document a significant increase in tumor size before instituting an intervention, such as initiating a dopamine agonist or surgery.…”

Section: European Journal Of Endocrinologymentioning

confidence: 99%

ENDOCRINOLOGY IN PREGNANCY: Management of the pregnant patient with a prolactinoma

Molitch

2015

European Journal of Endocrinology

142

135

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A woman with a prolactinoma is usually infertile. Dopamine agonists usually restore ovulation and fertility and such treatment generally is preferred over transsphenoidal surgery because of higher efficacy and safety. Cabergoline is usually preferred over bromocriptine because of its better efficacy with fewer adverse effects. Either drug increases the rates of spontaneous abortions, preterm deliveries, multiple births, or congenital malformations over what may be expected. However, the number of pregnancies reporting such experience is about sevenfold greater for bromocriptine. Tumor growth causing significant symptoms and requiring intervention has been reported to occur in 2.4% of those with microadenomas, 21% in those with macroadenomas without prior surgery or irradiation, and 4.7% of those with macroadenomas with prior surgery or irradiation. Visual fields should be assessed periodically during gestation in women with macroadenomas. If significant tumor growth occurs, most patients respond well to reinstitution of the dopamine agonist. Delivery of the baby and placenta can also be considered if the pregnancy is sufficiently advanced. Transsphenoidal debulking of the tumor is rarely necessary. Prolactin and fertilityWomen with hyperprolactinemia usually present with symptoms of galactorrhea, menstrual disorders (usually amenorrhea), and infertility. Hyperprolactinemia decreases luteinizing hormone (LH) pulse amplitude and frequency through suppression of gonadotropin-releasing hormone (GNRH) (1, 2). This effect appears to be mediated by an earlier step of suppressing the generation of kisspeptin, a protein made by neurons in the arcuate and periventricular nuclei of the hypothalamus, which stimulates GNRH release (3). Hyperprolactinemia has been associated with loss of the positive estrogen feedback on gonadotropin secretion at mid-cycle (4) but whether this effect is mediated through kisspeptin is not known.Direct prolactin (PRL) effects on ovarian granulosa cells include stimulation of the expression of type 2

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Section: European Journal Of Endocrinologymentioning

confidence: 99%

ENDOCRINOLOGY IN PREGNANCY: Management of the pregnant patient with a prolactinoma

Molitch

2015

European Journal of Endocrinology

142

135

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“…MR venography has therefore been suggested as an alternative imaging modality in pregnant patients with suspected isolated iliac DVT in whom the diagnosis cannot be confi rmed by ultrasonography. To date, there have only been limited data with regard to the safety of MR venography during organogenesis, but MR imaging techniques without contrast enhancement seem to be safe, especially after the fi rst trimester [62,63]. Gadolinium has been shown to cross the foetal blood-placental barrier and appear in the foetal bladder and the amniotic fl uid, where it can be swal- lowed and reabsorbed by the foetus [63,64].…”

Section: Magnetic Resonance Venographymentioning

confidence: 99%

Diagnosis of pregnancy-associated venous thromboembolism - position paper of the Working Group in Women’s Health of the Society of Thrombosis and Haemostasis (GTH)

Linnemann¹,

Scholz

Rott

et al. 2016

Vasa

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EpidemiologyVTE is a leading cause of maternal morbidity in the developed world and, in the case of PE, of mortality as well [1]. While the relative risk of VTE is greatly increased during pregnancy compared with that in non-pregnant women, the absolute risk remains low: estimates of the incidence of pregnancy-associated VTE have varied from 1:500 to 1:1500 pregnancies [2 -7]. The risk of VTE is approximately 5-fold greater in pregnant women than in non-pregnant women.Approximately 80 % of pregnancy-associated VTEs are isolated DVTs, and approximately 20 % are PEs or both DVTs and PEs [5]. Although a systematic review reported weighted event rates for DVT of 21.9 %, 33.7 % and 47.6 % for the fi rst, second and third trimesters, respectively [6], a recent study suggested that the risk might in fact increase exponentially over the duration of the pregnancy [7], with 12.4 % of VTEs diagnosed in the fi rst trimester, 15.3 % in the second trimester and 72.3 % in the third trimester. This detailed risk assessment for each gestational week demonstrated a 21-fold increased risk for the last two weeks before delivery [7]. Summary: Pregnancy and the postpartum period are associated with an increased risk of venous thromboembolism (VTE). Over the past decade, new diagnostic algorithms have been established, combining clinical probability, laboratory testing and imaging studies for the diagnosis of deep vein thrombosis (DVT) and pulmonary embolism (PE) in the non-pregnant population. However, there is no such generally accepted algorithm for the diagnosis of pregnancy-associated VTE. Studies establishing clinical prediction rules have excluded pregnant women, and prediction scores currently in use have not been prospectively validated in pregnancy or during the postpartum period. D-dimers physiologically increase throughout pregnancy and peak at delivery, so a negative D-dimer test result, based on the reference values of non-pregnant subjects, becomes unlikely in the second and third trimesters. Imaging studies therefore play a major role in confi rming suspected DVT or PE in pregnant women. Major concerns have been raised against radiologic imaging because of foetal radiation exposure, and doubts about the diagnostic value of ultrasound techniques in attempting to exclude isolated iliac vein thrombosis grow stronger as pregnancy progresses. As members of the Working Group in Women's Health of the Society of Thrombosis and Haemostasis (GTH), we summarise evidence from the available literature and aim to establish a more uniform strategy for diagnosing pregnancy-associated VTE. Review Diagnosis of pregnancy-associated

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“…MRG'nin zararlı etkisi olduğu gösterilememişse de gebelikte tamamen güvenilirliği de kanıtlanmamıştır (36). Ancak gerekli olduğu durumlarda 3. trimesterde kullanımı yaygındır ve genel olarak güvenli kabul edilir (37).…”

Section: Ayırıcı Tanıunclassified

Gebelik ile ilişkili Osteoporoz

Akyüz¹,

Bayındır²

2013

Tftr

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A review of the current use of magnetic resonance imaging in pregnancy and safety implications for the fetus

Cited by 303 publications

References 115 publications

ENDOCRINOLOGY IN PREGNANCY: Management of the pregnant patient with a prolactinoma

ENDOCRINOLOGY IN PREGNANCY: Management of the pregnant patient with a prolactinoma

Diagnosis of pregnancy-associated venous thromboembolism - position paper of the Working Group in Women’s Health of the Society of Thrombosis and Haemostasis (GTH)

Gebelik ile ilişkili Osteoporoz

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