RETIRED: The Use of Magnetic Resonance Imaging in the Obstetric Patient

Patenaude, Yves; Pugash, D.; Lim, Kenneth; Morin, Lucie; Bly, Sara; Butt, Kimberly; Cargill, Yvonne; Davies, Gregory; Denis, Nathalie; Hazlitt, Gail; Naud, Kentia; Ouellet, Annie; Salem, Shia

doi:10.1016/s1701-2163(15)30612-5

Cited by 167 publications

(98 citation statements)

References 27 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Organ dysfunction defi nes severe preeclampsia and can include hepatomegaly and hepatocellular injury. Up to 7.5% of all pregnancies are aff ected, but only 25% of preeclampsia cases are severe. Liver involvement is not a common expression and when it does occur symptoms are generally non-specifi c. Eclampsia is present when grand mal seizures occur ( 51 ).…”

Section: Preeclampsia and Eclampsiamentioning

confidence: 99%

ACG Clinical Guideline: Liver Disease and Pregnancy

Tran

Ahn

Reau

2016

American Journal of Gastroenterology

234

257

View full text Add to dashboard Cite

Consultation for liver disease in pregnant women is a common and oftentimes vexing clinical consultation for the gastroenterologist. The challenge lies in the need to consider the safety of both the expectant mother and the unborn fetus in the clinical management decisions. This practice guideline provides an evidence-based approach to common diagnostic and treatment challenges of liver disease in pregnant women. Am J Gastroenterol 2016; 111:176-194; doi: 10.1038/ajg.2015 Initial evaluation of pregnant patientA pregnant patient presenting with abnormal liver tests should undergo standard workup as with any non-pregnant individual (strong recommendation, very low level of evidence). Imaging in pregnancyUltrasound is safe and the preferred imaging modality used in assessment of abnormal liver tests suggestive of biliary tract disease (strong recommendation, low level of evidence).Magnetic resonance imaging without gadolinium can be used in the second and third trimester (conditional recommendation, low level of evidence).Computed tomography scans carry a risk of teratogenesis and childhood hematologic malignancies but may be used judiciously with minimized radiation protocols (2-5 rads; conditional recommendation, very low level of evidence). Endoscopy in pregnancyEndoscopy is safe in pregnancy but should be deferred until the second trimester if possible (strong recommendation, low level of evidence).Meperidine and propofol can be used for endoscopic sedation (strong recommendation, moderate level of evidence). Management of biliary disease in pregnancyERCP can be performed when indicated for pregnant women presenting with biliary disease that strongly necessitates intervention such as biliary pancreatitis, symptomatic choledocholithiasis, and/or cholangitis. Minimizing fetal exposure to fl uoroscopy is imperative (strong recommendation, low level of evidence).Symptomatic cholecystitis should be managed with early surgical intervention with laparoscopic cholecystectomy (strong recommendation, low level of evidence). Liver masses in pregnancyAsymptomatic hemangioma and focal nodular hyperplasia do not need routine imaging or surveillance during pregnancy (strong recommendation, very low level evidence).Hepatic adenomas should be monitored with ultrasound during pregnancy for growth. Patients with large adenomas (>5 cm) should be referred for resection prior to pregnancy (strong recommendation, low level of evidence). Hepatitis B in pregnancyActive-passive immunoprophylaxis with hepatitis B immunoglobulin and the HBV vaccination series should be administered to all infants born to HBV-infected mothers to prevent perinatal transmission (strong recommendation, low level of evidence).Women chronically infected with HBV and high viral load (>10 6 log copies/ml (200,000 IU/ml) and higher) should be offered antiviral medication with tenofovir or telbivudine in the third trimester to reduce perinatal transmission of HBV (strong recommendation, low level of evidence).C-section should not be performed electively in HBV-pos...

show abstract

Section: Preeclampsia and Eclampsiamentioning

confidence: 99%

ACG Clinical Guideline: Liver Disease and Pregnancy

Tran

Ahn

Reau

2016

American Journal of Gastroenterology

234

257

View full text Add to dashboard Cite

show abstract

“…A felmerülő esetleges magzati teratogén, szöveti hőmérsékletet káros mértékben emelő, illetve halláskárosító hatásokat az eddigi vizsgálatok nem bizonyították [27]. Mindezek alapján egyes ajánlá-sok szerint radiológus szakértő bevonásával és a haszonkockázat megfelelő értékelésével a terhesség bármely szakában (trimesztertől függetlenül) végezhető MRvizsgálat [21]; más irányelvek a terhesség első trimeszterében fokozott elővigyázatosságra hívják fel a figyelmet és csak klinikailag elengedhetetlen esetekben javasolják MR elvégzését, míg a második és harmadik ÖSSZEFOGLALÓ KÖZLEMÉNY trimeszterben a 3 teslás vagy annál kisebb erőterű MR-t biztonságosnak ítélik [28]. Az MR-képalkotás során az agyi vasculatura megjelenítésére lehetőség van kontrasztanyagot nem igénylő, úgynevezett time-of-flight (TOF) szekvenciával, illetve gadolíniumtartalmú kontrasztanyag adásával.…”

Section: Diagnosztikaunclassified

Terhesség és akut ischaemiás stroke

Bereczki

2016

Orvosi Hetilap

View full text Add to dashboard Cite

A graviditás alatt jelentkező ischaemiás stroke jelentős tényezője mind az anyai, mind a magzati morbiditásnak és mortalitásnak. A terhesség és gyermekágy során észlelt nagyobb kockázatot egyfelől a graviditással összefüggő haemostaseologiai és hemodinamikai változások, másfelől különböző, a terhességre specifikus és nem specifikus kocká-zati faktorok eredményezik. A diagnosztika, akut terápia és prevenció területén fontos kérdés a beavatkozások esetleges magzatkárosító veszélye. Multicentrikus regiszter létrehozása mindenképpen kívánatos volna a terhességi stroke alaposabb megismeréséhez. Tekintettel arra, hogy nagy esetszámú, randomizált, kontrollált vizsgálatok és ezekre alapozott definitív irányelvek nem állnak rendelkezésre, a terhesség alatt jelentkező akut stroke során minden esetben szakértők bevonásával és a haszon-kockázat megfelelő értékelésével kell egyénre szabott döntést hozni. Orv. Hetil., 2016, 157(20), 763-766. Kulcsszavak: terhesség, stroke, ischaemiás stroke Pregnancy and acute ischemic strokePregnancy-related ischemic strokes play an important role in both maternal and fetal morbidity and mortality. Changes in hemostaseology and hemodynamics as well as risk factors related to or independent from pregnancy contribute to the increased stroke-risk during gestation and the puerperium. Potential teratogenic effects make diagnostics, acute therapy and prevention challenging. Because randomized, controlled trials are not available, a multicenter registry of patients with gestational stroke would be desirable. Until definite guidelines emerge, management of acute ischemic stroke during pregnancy remains individual, involving experts and weighing the risks and benefits. Rövidítések CT = komputertomográfia; DWI = diffusion-weighted imaging; LMWH = low molecular weight heparin; MRI = mágne-sesrezonancia-vizsgálat; rtPA = rekombináns humán szöveti plazminogén aktivátor; TOF = time-of-flight; UFH = unfractionated heparin Ischaemiás stroke-ról beszélünk, ha a neurológiai funkció zavar hátterében fokális agyi, gerincvelői vagy retinalis infarktus áll [1]. A terhesség alatt jelentkező agyi érka-tasztrófa ugyan ritka esemény, mégis az egyébként alacsony rizikójú fiatal populációban bekövetkező strokeok 12-35%-áért és az anyai mortalitás 12%-áért felelős [2,3]. A gesztáció során a legnagyobb kockázatot a szü-lés körüli és gyermekágyi időszak jelenti [4]. Az ischaemiás stroke-ok 100 000 szülésre vonatkoztatott gyakorisága 4,3 és 210 közötti [5], azonban a szülési átlagéletkor elmúlt három évtizedben 24,6 évről 27,2 évre történő növekedésével [6] -és ezzel párhuzamosan a társuló cardiovascularis rizikófaktorok gyarapodásával [7] -össz-hangban emelkedő tendenciát mutat: az Amerikai Egyesült Államokban 1994 és 2007 között az antenatalis és post partum stroke miatti hospitalizációk 47%-kal, illetve 83%-kal nőttek [8]. Patogenezis és kockázati tényezőkA terhesség során észlelt emelkedett stroke-kockázathoz több tényező is hozzájárul. Ezek egyfelől a graviditással ÖSSZEFOGLALÓ KÖZLEMÉNY

show abstract

“…Several studies have been performed and so far have failed to show any adverse short-or long-term side effects of 1.5T MR imaging on fetal and postnatal development (6)(7)(8)(9). Although most fetal MR studies are performed on a 1.5T scanner, fetal MRI is also performed on 3T scanners, as they provide better anatomical detail.…”

Section: Fetal Safetymentioning

confidence: 99%

“…Although most fetal MR studies are performed on a 1.5T scanner, fetal MRI is also performed on 3T scanners, as they provide better anatomical detail. In the guidelines prepared in 2014 by Patenaude et al on the use of MRI in obstetric patients it is stated that "Fetal magnetic resonance imaging is safe at 3.0 tesla or less, during the second and third trimesters" (8). Due to the theoretical risk during organogenesis, when the fetus is also very small, it is advisable to avoid MRI during the first trimester.…”

Section: Fetal Safetymentioning

confidence: 99%

“…Due to the theoretical risk during organogenesis, when the fetus is also very small, it is advisable to avoid MRI during the first trimester. Some animal studies have shown the possibility of teratogenic effects in early prenatal development, but the applicability of these animal models to humans has been questioned (8)(9)(10)(11). Imaging younger fetuses can also be a challenge due to the small dimensions and fetal movements (12,13).…”

Section: Fetal Safetymentioning

confidence: 99%

See 1 more Smart Citation

A peek into the uterus – MRI of the fetal CNS

Vesnaver

2016

Pedaiatr Today

View full text Add to dashboard Cite

The purpose of this article is to provide an overview of MR imaging of the fetal central nervous system, and to briefly discuss recent advances. Fetal MRI has been commonly used throughout the world for over 20 years. Compared to US it has better contrast resolution, allows direct visualization of both hemispheres and the additional limitations of sonography do not affect the quality of MRI. There are no known adverse short-term or long-term side effects of MRI in children, who were imaged in the fetal period. The standard protocol for fetal MRI consists of single-shot rapid acquisition T2 weighted sequences in three planes, fast spoiled gradient recalled T1 weighted sequence, T2 gradient echo sequence and diffusion weighted sequence in the axial plane. The clinical applications of advanced MRI techniques are still limited. Fetal MRI is performed to confirm abnormalities detected on US, and to exclude additional pathology. Interpreting fetal MRI images requires understanding of normal fetal CNS development and one should also evaluate other fetal structures, the umbilical cord and placenta. The most common indication for MR imaging of the fetal CNS is mild ventriculomegaly. Other common indications, that are also discussed in the article, include commissural abnormalities, infratentorial abnormalities, cortical malformations, spinal pathology and complications of monochorionic twin pregnancy. ConclusionFetal MRI provides important information in prenatal counseling, therefore familiarity with the applications and limitations of fetal MRI, and multidisciplinary collaboration remain essential for the radiologist involved in prenatal imaging.

show abstract

RETIRED: The Use of Magnetic Resonance Imaging in the Obstetric Patient

Cited by 167 publications

References 27 publications

ACG Clinical Guideline: Liver Disease and Pregnancy

ACG Clinical Guideline: Liver Disease and Pregnancy

Terhesség és akut ischaemiás stroke

A peek into the uterus – MRI of the fetal CNS

Contact Info

Product

Resources

About