Imaging of Abdominal Pain in Pregnancy

Review of Operative vs. Non-Operative Management of Appendicitis in Pregnancy

“…Limiting doses of ionizing radiation as well as contrast agents that carry potential for fetal injury recommend ultrasound and MRI as preferred imaging techniques for pregnant patients [18, [130][131][132]. Since rates of fetal loss and early delivery are higher in women with perforation, and negative appendectomy rate higher in pregnant women, reducing risk of fetal loss relates directly to accuracy of diagnosis, with particular attention to accurate imaging interpretation, as most women have undergone some kind of imaging prior to evaluation by a surgeon.…”

A Free Terminal Ileal Perforation From Active Crohn Disease in Pregnancy: A Diagnostic Challenge

“…Although MR avoids fetal exposure to ionizing radiation and is being increasingly used for the evaluation of acute intestinal or biliary tract disease in pregnancy, a recent review reports a learning curve for MR examinations for acute appendicitis and specifically delineating right-lower quadrant anatomy in late second and third trimesters. 10 The estimated average dose from a single abdominal and pelvic CT examination is 17-25 milligray (mGy). Fetuses at 16 to 25 weeks are at risk of developing mental retardation at exposures greater than 250 mGy.…”

“…Fetuses at 16 to 25 weeks are at risk of developing mental retardation at exposures greater than 250 mGy. 10 Of more concern, however, is the unsettled controversy over increased risk of childhood cancer from exposure to ionizing radiation from abdominal and pelvic CT imaging. Studies in this regard have been equivocal with a recent population based study showing no difference in risk between exposed and unexposed groups.…”

“…Studies in this regard have been equivocal with a recent population based study showing no difference in risk between exposed and unexposed groups. 10 In a statement released by the International Commission on Radiological Protection, the best quantitative estimate of risk is approximately 1 cancer per 500 fetuses exposed to 30 mGy of radiation.…”

“…Thus, although ultrasound and MR imaging should be considered first in the evaluation of the pregnant patient, the risks from ionizing radiation exposure associated with abdominal and pelvic CT imaging are low and may be outweighed by the potential harm from a delayed or missed diagnosis. 10 In a more recent review on recommendations for abdominal pelvic imaging in pregnancy, the authors conclude that CT imaging should not be delayed when deemed necessary because of concerns about fetal exposure to ionizing radiation.…”