Imaging of Trauma: Part 2, Abdominal Trauma and Pregnancy—A Radiologist's Guide to Doing What Is Best for the Mother and Baby

Sadro, Claudia T.; Bernstein, Mark; Kanal, Kalpana M.

doi:10.2214/ajr.12.9091

Cited by 67 publications

(38 citation statements)

References 58 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…CT of the abdomen and pelvis is occasionally used in the evaluation of a pregnant patient, especially in the setting of blunt abdominal trauma [14]. However, the potential risks of fetal radiation exposure are of particular concern because the fetus receives direct radiation during this examination.…”

Section: Discussionmentioning

confidence: 99%

“…Splenic injury is the most common cause of hemoperitoneum in both nonpregnant and pregnant patients, with possible increased risk in pregnancy because of the mild enlargement normally found with pregnancy [15]. The kidneys also mildly enlarge, and the liver and spleen are displaced superiorly and compressed against the ribs, making these organs more susceptible to injury [14, 22]. CT remains the modality of choice for the detection of solid organ injury both in pregnant and nonpregnant patients.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

JOURNAL CLUB: Quantification of Fetal Dose Reduction if Abdominal CT Is Limited to the Top of the Iliac Crests in Pregnant Patients With Trauma

Corwin

Seibert

Fananapazir

et al. 2016

American Journal of Roentgenology

View full text Add to dashboard Cite

OBJECTIVE The purposes of this study were to correlate fetal z-axis location within the maternal abdomen on CT with gestational age and estimate fetal dose reduction of a study limited to the abdomen only, with its lower aspect at the top of the iliac crests, compared with full abdominopelvic CT in pregnant trauma patients. MATERIALS AND METHODS We performed a study of pregnant patients who underwent CT of the abdomen and pelvis for trauma at a single institution over a 10-year period. The inferior aspect of maternal liver, spleen, gallbladder, pancreas, adrenals, and kidneys was recorded as above or below the iliac crests. The distance from the iliac crest to the top of the fetus or gestational sac was determined. The CT images of the limited and full scanning studies were independently reviewed by two blinded radiologists to identify traumatic injuries. Fetal dose profiles, including both scatter and primary radiation, were computed analytically along the central axis of the patient to estimate fetal dose reduction. Linear regression analysis was performed between gestational age and distance of the fetus to the iliac crests. RESULTS Thirty-five patients were included (mean age, 26.2 years). Gestational age ranged from 5 to 38 weeks, with 5, 19, and 11 gestations in the first, second, and third trimesters, respectively. All solid organs were above the iliac crests in all patients. In three of six patients, traumatic findings in the pelvis would have been missed with the limited study. There was high correlation between gestational age and distance of the fetus to the iliac crests (R2 = 0.84). The mean gestational age at which the top of the fetus was at the iliac crest was 17.3 weeks. Using the limited scanning study, fetuses at 5, 20, and 40 weeks of gestation would receive an estimated 4.3%, 26.2%, and 59.9% of the dose, respectively, compared with the dose for the full scanning study. CONCLUSION In pregnant patients in our series with a history of trauma, CT of the abdomen only was an effective technique to reduce fetal radiation exposure compared with full abdomen and pelvis CT.

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

JOURNAL CLUB: Quantification of Fetal Dose Reduction if Abdominal CT Is Limited to the Top of the Iliac Crests in Pregnant Patients With Trauma

Corwin

Seibert

Fananapazir

et al. 2016

American Journal of Roentgenology

View full text Add to dashboard Cite

show abstract

“…TraumaNetzwerk DGU  Um die bundesweite Implementierung, Anpassung und Einhaltung der in diesem Artikel genannten Voraussetzungen zur Schwerverletztenbehandlung zu gewährleisten, wurde von der DGU das Projekt TraumaNetzwerk DGU initiiert [35,36]. Darin arbeiten alle teilnehmenden Kliniken nach festgelegten Standards, um eine flächendeckende, qualitativ gleichwertige Versorgung zu bieten.…”

Section: Cmeunclassified

Schockraummanagement

Krueger

Frink

Kießling

et al. 2013

Chirurg

View full text Add to dashboard Cite

The treatment of the severely injured is, just as the injury severity and combinations, often highly complex and leaves little leeway for delay, dissent or even error. In order to reduce this to a minimum, trained emergency room teams in addition to optimal technical and structural prerequisites are necessary. This must function in an interdisciplinary fashion according to fixed consensus algorithms which are known to all team members and have been agreed by all participants. The White Paper on treatment of the severely injured of the German Society of Trauma Surgery (DGU) and the recently published S3 guidelines offer evidence-based recommendations on the structural, technical, organizational and personnel prerequisites.

show abstract

“…Of these, up to 59% can suffer from placental abruption and 11% may face fetal demise from placental and non-placental causes (2, 3). Despite known limitations of ultrasound, it is still a widely used modality for the evaluation of trauma in pregnant patients given the absence of radiation with this modality (3, 4). In addition to the well-known limitations of ultrasound in detecting maternal trauma, fetal and placental evaluations with ultrasound are also fraught with poor sensitivity (4).…”

Section: Introductionmentioning

confidence: 99%

“…Despite known limitations of ultrasound, it is still a widely used modality for the evaluation of trauma in pregnant patients given the absence of radiation with this modality (3, 4). In addition to the well-known limitations of ultrasound in detecting maternal trauma, fetal and placental evaluations with ultrasound are also fraught with poor sensitivity (4). Multiple review articles have alluded to this limitation, but an objective evaluation has not been yet performed (3–6).…”

Section: Introductionmentioning

confidence: 99%

Trauma in pregnant women: assessing detection of post-traumatic placental abruption on contrast-enhanced CT versus ultrasound

et al. 2016

View full text Add to dashboard Cite

Objectives To evaluate detection of post-traumatic placental abruption with contrast-enhanced CT (CECT) and comparison with Ultrasound (US). Methods Picture Archive and Date System (PACS) database at a level-1 trauma center was retrospectively reviewed using keywords pregnancy, trauma, and/or placental abruption over 10 years. CT was compared to US, if performed within 24 hours. 2 subspecialty-trained radiologists blindly reviewed the studies. Placental features on delivery and pregnancy outcomes were used as reference standard. Lack of adverse pregnancy/fetal outcome was treated as the absence of abruption. Results CECT was performed in 36 patients, with 27 US within 24 hours. There were 3 complete and 8 partial abruptions. Reader sensitivity for CT was 100% for both reviewers; however, specificity was 54.5% and 56.7%. No sonographic abnormality was noted in both partial and complete abruption. Using kappa statistics, inter-observer agreement was low for both CT (0.169) and US (0.078). False-positive reads were from misinterpretation of normal placental structures like cotyledons, age-related infarcts, and marginal sinus of the placenta. Conclusions CECT identifies post-traumatic placental abruption with high sensitivity but low specificity for clinically significant abruptions, and performs better than US. Pitfalls from normal placental structures mimicking abruption should be avoided. US markedly underdiagnoses abruption.

show abstract

Imaging of Trauma: Part 2, Abdominal Trauma and Pregnancy—A Radiologist's Guide to Doing What Is Best for the Mother and Baby

Cited by 67 publications

References 58 publications

JOURNAL CLUB: Quantification of Fetal Dose Reduction if Abdominal CT Is Limited to the Top of the Iliac Crests in Pregnant Patients With Trauma

JOURNAL CLUB: Quantification of Fetal Dose Reduction if Abdominal CT Is Limited to the Top of the Iliac Crests in Pregnant Patients With Trauma

Schockraummanagement

Trauma in pregnant women: assessing detection of post-traumatic placental abruption on contrast-enhanced CT versus ultrasound

Contact Info

Product

Resources

About