Safety of ultrasonography in pregnancy: WHO systematic review of the literature and meta‐analysis

Torloni, Maria Regina; Vedmedovska, Natālija; Merialdi, Mario; Betrán, Ana Pilar; Allen, Tomas; González, Ricardo Rodríguez; Platt, Lawrence D.

doi:10.1002/uog.6328

Cited by 177 publications

(149 citation statements)

References 82 publications

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“…Any pregnant woman presenting with abnormal aminotransferases or jaundice should fi rst undergo an abdominal ultrasound. Ultrasound, with or without Doppler imaging, as it uses sound waves and not ionizing radiation, has never been shown to have any adverse fetal eff ects ( 4,5 ). Th erefore, there are no contraindications to ultrasound in pregnancy and it should be used as the imaging modality of choice.…”

Section: Recommendationsmentioning

confidence: 99%

ACG Clinical Guideline: Liver Disease and Pregnancy

Tran

Ahn

Reau

2016

American Journal of Gastroenterology

234

257

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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...

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Section: Recommendationsmentioning

confidence: 99%

ACG Clinical Guideline: Liver Disease and Pregnancy

Tran

Ahn

Reau

2016

American Journal of Gastroenterology

234

257

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“…Current evidence regarding the safety of ultrasound, including a recent metaanalysis pooling and evaluating data from these existing trials, is overall reassuring (Torloni et al, 2009). Much data, however, has been obtained using ultrasound machines with far less output potential than available today.…”

Section: Discussionmentioning

confidence: 99%

The safety of obstetrical ultrasound: a review

2009

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Ultrasound is a commonly employed imaging modality in obstetrics and is generally regarded as safe to the fetus. Current ultrasound technology, however, has significantly higher output potential than older machines used in most clinical studies, and the safety profile for the increasing use of Doppler, 3-dimensional (D) and 4-D ultrasound with modern machines is unknown. This article reviews the current status of ultrasound safety within obstetrics, including proposed mechanisms of harm, existing scientific and clinical evidence regarding those mechanisms, and considerations of safety for the clinical user.

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“…There have been reports of a mildly increased risk of delayed speech, left handedness in boys and intrauterine growth restriction after fetal exposure to ultrasound 18 . A recent systematic review found that ultrasonography during pregnancy was not associated with adverse perinatal or childhood outcome 19 . However, in most of the reviewed studies ultrasound machines were used with less output potential than currently available 18 .…”

Section: Data)mentioning

confidence: 99%

State of the Art Cranial Ultrasound Imaging in Neonates

Ecury-Goossen

Camfferman

Leijser

et al. 2015

JoVE

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Cranial ultrasound (CUS) is a reputable tool for brain imaging in critically ill neonates. It is safe, relatively cheap and easy to use, even when a patient is unstable. In addition it is radiation-free and allows serial imaging. CUS possibilities have steadily expanded. However, in many neonatal intensive care units, these possibilities are not optimally used. We present a comprehensive approach for neonatal CUS, focusing on optimal settings, different probes, multiple acoustic windows and Doppler techniques. This approach is suited for both routine clinical practice and research purposes. In a live demonstration, we show how this technique is performed in the neonatal intensive care unit. Using optimal settings and probes allows for better imaging quality and improves the diagnostic value of CUS in experienced hands. Traditionally, images are obtained through the anterior fontanel. Use of supplemental acoustic windows (lambdoid, mastoid, and lateral fontanels) improves detection of brain injury. Adding Doppler studies allows screening of patency of large intracranial arteries and veins. Flow velocities and indices can be obtained. Doppler CUS offers the possibility of detecting cerebral sinovenous thrombosis at an early stage, creating a window for therapeutic intervention prior to thrombosis-induced tissue damage. Equipment, data storage and safety aspects are also addressed. Video LinkThe video component of this article can be found at

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Safety of ultrasonography in pregnancy: WHO systematic review of the literature and meta‐analysis

Abstract: Objective In the context of the planned International Society of Ultrasound in Obstetrics and

Cited by 177 publications

References 82 publications

ACG Clinical Guideline: Liver Disease and Pregnancy

ACG Clinical Guideline: Liver Disease and Pregnancy

The safety of obstetrical ultrasound: a review

State of the Art Cranial Ultrasound Imaging in Neonates

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