see also: [[Resuscitative Hysterotomy|pregnant trauma]], [[radiation in pregnancy and diagnostic imaging]] > **Note:** this is an earlier version of the [[radiation in pregnancy and diagnostic imaging]] note [Imaging of trauma in the pregnant patient.](bookends://sonnysoftware.com/ref/DL/58403) [RMH rose 2015 radiation fear: compliance with trauma imaging guidelines in pregnant patient](bookends://sonnysoftware.com/ref/DL/88675) [Diagnostic imaging during pregnancy and lactation - first 10 EM](cubox://card?id=7126247982034321620) # Guidelines 2008 ACR (supported by ACOG and NCRP): > fetal radiation **doses of less than 50mGy** are NOT associated with increased fatal anomalies or fetal loss throughout pregnancy # Radiation - relative risk of 2 for radiation doses > 50mGy - 1/2000 --> 1/1000 - lifetime risk of cancer increased by 2% - 40% --> 42% | Weeks | stage of development | biologic effects | | :-------------- | :--------------------------------------------------------- | :------------------------------------------------------------------------------------------------------------------------------------ | | 0-2 | pre-implantation | prenatal death, risks at >50-100mGy | | 2-8 | major organogenesis | organ malformations.  risk >100mGy (but not observed in humans at diagnostic levels) | | 2-15 | organogenesis and rapid neuronal development and migration | small head, risk >100mGy.  severe mental retardation >100mGy.   | | 2 weeks to term | postimplantation | childhood cancer (15 years old).risk of childhood cancer death 0.06% per 10mGy (or 1/1700).  lifetime cancer risk 0.4% per 10mGy | \^ table from [Sadro et al 2012 AJR: Imaging of trauma: Part 2, Abdominal trauma and pregnancy--a radiologist's guide to doing what is best for the mother and baby.](bookends://sonnysoftware.com/ref/DL/265120) ![[Pasted image 20230513204712.png]] ![[Pasted image 20230513204720.png| Raptis et al 2014 Radiographics]] ## risks are overweighed # Modalities ## CXR - as usual, no lead apron ## Pelvic XR - do as indicated ## E-fast - free fluid harder to detect (raptis et al 2014 radiographics ## CT - discuss indications - take usual necessary steps to minimise radiation - wedge whilst supine to roll gravid uterus off IVC - IV contrast - FDA cat B drug - no effect on fetus - no effect on fetal thyroid function - but ACR -- insufficient evidecne to say NO risk - CT chest risks to mum breast tissue > to foetus ## angiography - focal radiation - radiation reduction strategies - minimise fluoro time - decrase fluor frame rate - etc other stuff from interventional radiology # Injuries in pregnant trauma 1. non-pregnancy related (eg spine fracture, subdural haemorrhage, etc) 2. pregnancy-related injuries 3. obstetric injuries ## pregnancy-related injuries increased risk due to pregnacy - spleen, liver -- injury due to higher location from pregnancy, bigger - bladder -- rupture - hydronephrosis -- rupture - ovarian veins -- retroperitoneal haemorrhage - pelvic fractures -- higher risk of foetal mortality ## obstetric injuries gravid uterus and its contents 1. placental abrution 2. uterine rupture 3. PROM 4. spontaneous abortion ### traumatic placental abruption - most common cause of foetal death when mother survives (75% foetal mortality) - retroplacental worse prognosis - assess with CT ultrasound **50-80% false negative** -- looking for hypoechoic fluid btwn placenta and myometrium ![[Pasted image 20230513221231.png]] ^ retroplacental abruption with a calcified margin of the placenta mimics: - contractions - plancental infarcts ### uterine rupture - rare - nearly 100% foetal mortality - risk factors: prior c-section, prior uterine intervention, congenital uterine abnormalities - USS -- poor - CT -- better disruption of uterine wall --> foetal extrusion --> haemoperitoneum ### premature rupture of membranes (PROM) - still a clinical diagnosis - low amniotic vluid volume may be seen on POCUS ### spontaneous aboriton - first trimester - USS findings same as for non-traumatic patient # related questions ## trauma in pregnancy - [trauma in pregnancy](x-devonthink-item://92A26505-5B6B-4ADD-995F-6AAA2E05C637?page=2) -- [Answer](x-devonthink-item://0808A030-AF19-4671-BE84-3E8BCBEC6124?page=2) - [Pregnant Lady who fell down the stairs](x-devonthink-item://CDB16617-3785-40E5-B8BE-5668D2D7A3E7?page=10) -- [Answer](x-devonthink-item://A6CA01E8-9551-45E7-8617-441BE3DBB5D7?page=9) - [Pregnant Trauma](x-devonthink-item://09CFA1A7-00F1-4151-979E-8F3984924D54?page=32) -- [Answer](x-devonthink-item://CF5E9C2B-42F9-4F9C-AC29-877E20134927?page=21) - [Trauma in Pregnancy](x-devonthink-item://662C8511-01CD-4659-B57D-5A01CF74D69B?page=6) -- [Answer](x-devonthink-item://79A95C0A-634E-4B38-9131-78949F63D56F?page=4) - [Resuscitative hysterotomy](x-devonthink-item://7E9EF652-F67B-42C5-A536-2EE85BA1954F?page=3) -- [Answer](x-devonthink-item://2DE5FACA-6D8F-41A2-8EAA-8DFE1E76FA61?page=1) - [Trauma in Pregnancy](x-devonthink-item://85167CB5-A7B5-4BF3-9BC7-AC46D5538A42?page=6) -- [Answer](x-devonthink-item://5B03E66C-E043-4EB7-A5F6-7389CB927BD7?page=8)