Challenges in Interventional Radiology: The Pregnant Patient

Abstract

A pregnant patient presenting to interventional radiology (IR) has a different set of needs from any other patient requiring a procedure. Often, the patient's care can be in direct conflict with the growth and development of the fetus, whether it be optimal fluoroscopic imaging, adequate sedation of the mother, or the timing of the needed procedure. Despite the additional risks and complexities associated with pregnancy, IR procedures can be performed safely for the pregnant patient with knowledge of the special and general needs of the pregnant patient, use of acceptable medications and procedures likely to be encountered during pregnancy, in addition to strategies to protect the patient and her fetus from the hazards of radiation.

Keywords

pregnancy - interventional radiology - medication - radiation safety

• References

• 1 American College of Radiology. ACR practice guideline for imaging pregnant or potentially pregnant adolescents and women with ionizing radiation. Reston, VA: ACR; 2008
• 2 Gilinsky NH, Muthunayagam N. Gastrointestinal endoscopy in pregnant and lactating women: emerging standard of care to guide decision-making. Obstet Gynecol Surv 2006; 61 (12) 791-799
• 3 Walton NKD, Melachuri VK. Anaesthesia for non-obstetric surgery during pregnancy. Continuing education in anaesthesia. Critical Care Pain 2006; 6 (2) 83-85
• 4 Dauer LT, Thornton RH, Miller DL , et al. Radiation management for interventions using fluoroscopic or computed tomographic guidance during pregnancy: A joint guideline of the Society of Interventional Radiology and the Cardiovascular and Interventional Radiology and the Cardiovascular and Interventional Radiology Society of Europe with Endorsement by the Canadian Interventional Radiology Association. J Vasc Interv Radiol 2012; 23 (1) 19-32
• 5 Tsuei BJ. Assessment of the pregnant trauma patient. Injury 2006; 37 (5) 367-373
• 6 Mitrut P, Docea AO, Calina CD, Streba L, Endoscopy in pregnancy. In: Amornyotin S. , ed., Endoscopy; 2013. ISBN: 978–953–51–1071–2, InTech, DOI: 10.5772/52550. Available from http://www.intechopen.com/books/endoscopy/endoscopy-in-pregnancy
• 7 Qureshi WA, Rajan E, Adler DG , et al; American Society for Gastrointestinal Endoscopy. ASGE guideline: Guidelines for endoscopy in pregnant and lactating women. Gastrointest Endosc 2005; 61 (3) 357-362
• 8 Marx MV. Interventional radiology: management of the pregnant patient. Tech Vasc Interv Radiol 2010; 13 (3) 154-157
• 9 International Commission on Radiological Protection. Pregnancy and medical radiation. Ann ICRP 2000; 30 (1) 1-43
• 10 Thabet A, Kalva SP, Liu B, Mueller PR, Lee SI. Interventional radiology in pregnancy complications: indications, technique, and methods for minimizing radiation exposure. Radiographics 2012; 32 (1) 255-274
• 11 McCollough CH, Schueler BA, Atwell TD , et al. Radiation exposure and pregnancy: when should we be concerned?. Radiographics 2007; 27 (4) 909-917 , discussion 917–918
• 12 Koller CJ, Eatough JP, Bettridge A. Variations in radiation dose between the same model of multislice CT scanner at different hospitals. Br J Radiol 2003; 76 (911) 798-802
• 13 Streffer C, Shore R, Konermann G , et al; H R. Biological effects after prenatal irradiation (embryo and fetus). A report of the International Commission on Radiological Protection. Ann ICRP 2003; 33 (1–2) 5-206
• 14 Wieseler KM, Bhargava P, Kanal KM, Vaidya S, Stewart BK, Dighe MK. Imaging in pregnant patients: examination appropriateness. Radiographics 2010; 30 (5) 1215-1229 , discussion 1230–1233
• 15 Sadro C, Bernstein MP, Kanal KM. Imaging of trauma: Part 2, Abdominal trauma and pregnancy—a radiologist's guide to doing what is best for the mother and baby. AJR Am J Roentgenol 2012; 199 (6) 1207-1219
• 16 Watson WJ, Brost BC. Maternal hydronephrosis in pregnancy: poor association with symptoms of flank pain. Am J Perinatol 2006; 23 (8) 463-466
• 17 Weerakkody Y. Maternal hydronephrosis in pregnancy. Available from Radiopaedia.org/articles/maternal-hydronephrosis-in-pregnancy . Accessed July 24, 2013
• 18 vanSonnenberg E, Casola G, Talner LB, Wittich GR, Varney RR, D'Agostino HB. Symptomatic renal obstruction or urosepsis during pregnancy: treatment by sonographically guided percutaneous nephrostomy. AJR Am J Roentgenol 1992; 158 (1) 91-94
• 19 Bourjeily G, Chalhoub M, Phornphutkul C, Alleyne TC, Woodfield CA, Chen KK. Neonatal thyroid function: effect of a single exposure to iodinated contrast medium in utero. Radiology 2010; 256 (3) 744-750
• 20 Rajaram S, Exley CE, Fairlie F, Matthews S. Effect of antenatal iodinated contrast agent on neonatal thyroid function. Br J Radiol 2012; 85 (1015) e238-e242
• 21 Kavoussi LR, Albala DM, Basler JW, Apte S, Clayman RV. Percutaneous management of urolithiasis during pregnancy. J Urol 1992; 148 (3, Pt 2) 1069-1071
• 22 Allmendinger N, Hallisey MJ, Ohki SK, Straub JJ. Percutaneous cholecystostomy treatment of acute cholecystitis in pregnancy. Obstet Gynecol 1995; 86 (4, Pt 2) 653-654
• 23 Little MW, Briggs JH, Tapping CR , et al. Percutaneous cholecystostomy: the radiologist's role in treating acute cholecystitis. Clin Radiol 2013; 68 (7) 654-660
• 24 Requarth J. Ultrasound-guided percutaneous cholecystostomy in pregnancy. J Am Coll Surg 2010; 211 (1) 145
• 25 Pitchumoni CS, Yegneswaran B. Acute pancreatitis in pregnancy. World J Gastroenterol 2009; 15 (45) 5641-5646
• 26 James AH. Venous thromboembolism in pregnancy. Arterioscler Thromb Vasc Biol 2009; 29 (3) 326-331
• 27 Benson MD. Pulmonary embolism in pregnancy. Consensus and controversies. Minerva Ginecol 2012; 64 (5) 387-398
• 28 Caplin DM, Nikolic B, Kalva SP, Ganguli S, Saad WE, Zuckerman DA ; Society of Interventional Radiology Standards of Practice Committee. Quality improvement guidelines for the performance of inferior vena cava filter placement for the prevention of pulmonary embolism. J Vasc Interv Radiol 2011; 22 (11) 1499-1506
• 29 Sadashivaiah J, Wilson R, Thein A, McLure H, Hammond CJ, Lyons G. Role of prophylactic uterine artery balloon catheters in the management of women with suspected placenta accreta. Int J Obstet Anesth 2011; 20 (4) 282-287
• 30 Flik K, Kloen P, Toro JB, Urmey W, Nijhuis JG, Helfet DL. Orthopaedic trauma in the pregnant patient. J Am Acad Orthop Surg 2006; 14 (3) 175-182
• 31 Mirza FG, Devine PC, Gaddipati S. Trauma in pregnancy: a systematic approach. Am J Perinatol 2010; 27 (7) 579-586
• 32 Salazar GM, Walker TG. Evaluation and management of acute vascular trauma. Tech Vasc Interv Radiol 2009; 12 (2) 102-116
• 33 Nahum GG, Uhl K, Kennedy DL. Antibiotic use in pregnancy and lactation: what is and is not known about teratogenic and toxic risks. Obstet Gynecol 2006; 107 (5) 1120-1138
• 34 Bettmann MA. Frequently asked questions: iodinated contrast agents. Radiographics 2004; 24 (Suppl. 01) S3-S10
• 35 ACOG Committee Opinion. Guidelines for diagnostic imaging during pregnancy. Reaffirmed 2009. ACOG Committee on Obstetric Practice. 2004; 299: 1-5
• 36 Chen MM, Coakley FV, Kaimal A, Laros Jr RK. Guidelines for computed tomography and magnetic resonance imaging use during pregnancy and lactation. Obstet Gynecol 2008; 112 (2, Pt 1): 333-340
• 37 Widmark JM. Imaging-related medications: a class overview. Proc (Bayl Univ Med Cent) 2007; 20 (4) 408-417
• 38 Steinberg ES, Santos AC. Surgical anesthesia during pregnancy. Int Anesthesiol Clin 1990; 28 (1) 58-66
• 39 Broussard CS, Rasmussen SA, Reefhuis J , et al; National Birth Defects Prevention Study. Maternal treatment with opioid analgesics and risk for birth defects. Am J Obstet Gynecol 2011; 204 (4) e1-e11
• 40 Allegaert K, van Mieghem T, Verbesselt R , et al. Cefazolin pharmacokinetics in maternal plasma and amniotic fluid during pregnancy. Am J Obstet Gynecol 2009; 200 (2) e1-e7
• 41 Lin KJ, Mitchell AA, Yau WP, Louik C, Hernández-Díaz S. Safety of macrolides during pregnancy. Am J Obstet Gynecol 2013; 208 (3) e1-e8
• 42 Romøren M, Lindbæk M, Nordeng H. Pregnancy outcome after gestational exposure to erythromycin—a population-based register study from Norway. Br J Clin Pharmacol 2012; 74 (6) 1053-1062
• 43 Crider KS, Cleves MA, Reefhuis J, Berry RJ, Hobbs CA, Hu DJ. Antibacterial medication use during pregnancy and risk of birth defects: National Birth Defects Prevention Study. Arch Pediatr Adolesc Med 2009; 163 (11) 978-985
• 44 Reyes MP, Ostrea Jr EM, Cabinian AE, Schmitt C, Rintelmann W. Vancomycin during pregnancy: does it cause hearing loss or nephrotoxicity in the infant?. Am J Obstet Gynecol 1989; 161 (4) 977-981
• 45 Berkovitch M, Pastuszak A, Gazarian M, Lewis M, Koren G. Safety of the new quinolones in pregnancy. Obstet Gynecol 1994; 84 (4) 535-538
• 46 Schaefer C, Amoura-Elefant E, Vial T , et al. Pregnancy outcome after prenatal quinolone exposure. Evaluation of a case registry of the European Network of Teratology Information Services (ENTIS). Eur J Obstet Gynecol Reprod Biol 1996; 69 (2) 83-89
• 47 Cooper WO, Hernandez-Diaz S, Arbogast PG , et al. Antibiotics potentially used in response to bioterrorism and the risk of major congenital malformations. Paediatr Perinat Epidemiol 2009; 23 (1) 18-28
• 48 Ward K, Theiler RN. Once-daily dosing of gentamicin in obstetrics and gynecology. Clin Obstet Gynecol 2008; 51 (3) 498-506
• 49 Kirkwood A, Harris C, Timar N, Koren G. Is gentamicin ototoxic to the fetus?. J Obstet Gynaecol Can 2007; 29 (2) 140-145
• 50 Matok I, Gorodischer R, Koren G, Sheiner E, Wiznitzer A, Levy A. The safety of metoclopramide use in the first trimester of pregnancy. N Engl J Med 2009; 360 (24) 2528-2535
• 51 Sheehan P. Hyperemesis gravidarum—assessment and management. Aust Fam Physician 2007; 36 (9) 698-701
• 52 Pasternak B, Svanström H, Hviid A. Ondansetron in pregnancy and risk of adverse fetal outcomes. N Engl J Med 2013; 368 (9) 814-823
• 53 Bártfai Z, Kocsis J, Puhó EH, Czeizel AE. A population-based case-control teratologic study of promethazine use during pregnancy. Reprod Toxicol 2008; 25 (2) 276-285
• 54 Hall PF. Use of promethazine (Phenergan) in labour. CMAJ 1987; 136 (7) 690-691
• 55 Czeizel AE, Vargha P. A case-control study of congenital abnormality and dimenhydrinate usage during pregnancy. Arch Gynecol Obstet 2005; 271 (2) 113-118
• 56 Brost BC, Scardo JA, Newman RB. Diphenhydramine overdose during pregnancy: lessons from the past. Am J Obstet Gynecol 1996; 175 (5) 1376-1377
• 57 Singh RR, Cuffe JS, Moritz KM. Short- and long-term effects of exposure to natural and synthetic glucocorticoids during development. Clin Exp Pharmacol Physiol 2012; 39 (11) 979-989
• 58 Kurtoğlu S, Sarıcı D, Akın MA, Daar G, Korkmaz L, Memur S. Fetal adrenal suppression due to maternal corticosteroid use: case report. J Clin Res Pediatr Endocrinol 2011; 3 (3) 160-162
• 59 Khan AA, Rodriguez A, Kaakinen M, Pouta A, Hartikainen AL, Jarvelin MR. Does in utero exposure to synthetic glucocorticoids influence birthweight, head circumference and birth length? A systematic review of current evidence in humans. Paediatr Perinat Epidemiol 2011; 25 (1) 20-36