Read terms. Wharton, MD. This document reflects emerging clinical and scientific advances as of the date issued and is subject to change. The information should not be construed as dictating an exclusive course of treatment or procedure to be followed. However, confusion about the safety of these modalities for pregnant and lactating women and their infants often results in unnecessary avoidance of useful diagnostic tests or the unnecessary interruption of breastfeeding. Ultrasonography and magnetic resonance imaging are not associated with risk and are the imaging techniques of choice for the pregnant patient, but they should be used prudently and only when use is expected to answer a relevant clinical question or otherwise provide medical benefit to the patient.
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Methods for estimating the due date. Committee Opinion No. American College of Obstetricians and Gynecologists. Obstet Gynecol ;e Promoted articles advertising. Commonly used for the evaluation of significant medical problems or trauma, X-ray procedures are indicated during pregnancy or may occur inadvertently before the diagnosis of pregnancy. In addition, it is estimated that a fetus will be exposed to 1 mGy of background radiation during pregnancy 2.
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Various units used to measure X-ray radiation are summarized in Table 1. Concerns about the use of X-ray procedures during pregnancy stem from the risks associated with fetal exposure to ionizing radiation. The risk to a fetus from ionizing radiation is dependent on the gestational age at the time of exposure and the dose of radiation If extremely high-dose exposure in excess of 1 Gy occurs during early embryogenesis, it most likely will be lethal to the embryo Table 2 15 However, these dose levels are not used in diagnostic imaging.
In humans, growth restriction, microcephaly, and intellectual disability are the most common adverse effects from high-dose radiation exposure Table 2 2 With regard to intellectual disability, based on data from atomic bomb survivors, it appears that the risk of central nervous system effects is greatest with exposure at weeks of gestation.
It has been suggested that a minimal threshold for this adverse effect may be in the range of mGy 2 18 ; however, the lowest clinically documented dose to produce severe intellectual disability is mGy 14 Even multiple diagnostic X-ray procedures rarely result in ionizing radiation exposure to this degree. Fetal risk of anomalies, growth restriction, or abortion have not been reported with radiation exposure of less than 50 mGy, a level above the range of exposure for diagnostic procedures In rare cases in which there are exposures above this level, patients should be counseled about associated concerns and individualized prenatal diagnostic imaging for structural anomalies and fetal growth restriction Table 3 The risk of carcinogenesis as a result of in-utero exposure to ionizing radiation is unclear but is probably very small.
A mGy fetal exposure may increase the risk of leukemia by a factor of 1. Thus, pregnancy termination should not be recommended solely on the basis of exposure to diagnostic radiation.
Should a pregnant woman undergo multiple imaging studies using ionizing radiation, it is prudent to consult with a radiation physicist to calculate the total dose received by the fetus. The Health Physics Society maintains a website with an ask-the-expert feature: www.
There is no risk to lactation from external sources of ionizing radiation diagnostic X-rays Use of CT and associated contrast material should not be withheld if clinically indicated, but a thorough discussion of risks and benefits should take place 8. In the evaluation for acute processes such as appendicitis or small-bowel obstruction, the maternal benefit from early and accurate diagnosis may out-weigh the theoretical fetal risks. If accessible in a timely manner, MRI should be considered as a safer alternative to CT imaging during pregnancy in cases in which they are equivalent for the diagnosis in question.
Radiation exposure from CT procedures varies depending on the number and spacing of adjacent image sections Table 2. For example, CT pelvimetry exposure can be as high as 50 mGy but can be reduced to approximately 2.
In the case of suspected pulmonary embolism, CT evaluation of the chest results in a lower dose of fetal exposure to radiation compared with ventilation-perfusion scanning 2.
With typical use, the radiation exposure to the fetus from spiral CT is comparable with conventional CT. Oral contrast agents are not absorbed by the patient and do not cause real or theoretical harm. The use of intravenous contrast media aids in CT diagnosis by providing for enhancement of soft tissues and vascular structures. The contrast most commonly used for CT is iodinated media, which carries a low risk of adverse effects eg, nausea, vomiting, flushing, pain at injection site and anaphylactoid reactions 9.
Although iodinated contrast media can cross the placenta and either enter the fetal circulation or pass directly into the amniotic fluid 22animal studies have reported no teratogenic or mutagenic effects from its use 8 Additionally, theoretical concerns about the potential adverse effects of free iodide on the fetal thyroid gland have not been borne out in human studies Despite this lack of known harm, it generally is recommended that contrast only be used if absolutely required to obtain additional diagnostic information that will affect the care of the fetus or woman during the pregnancy.
Traditionally, lactating women who receive intravascular iodinated contrast have been advised to discontinue breastfeeding for 24 hours.
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Therefore, breastfeeding can be continued without interruption after the use of iodinated contrast 1 9 13 16 This type of imaging is used to determine physiologic organ function or dysfunction rather than to delineate anatomy.
Hybrid systems, which combine the function of nuclear imaging devices with computed tomography, improve the quality of information acquired and can help to correct artifacts produced by nuclear medicine imaging alone 9. In pregnancy, fetal exposure during nuclear medicine studies depends on the physical and biochemical properties of the radioisotope.
Technetium 99m is one of the most commonly used isotopes and is used for brain, bone, renal, and cardiovascular scans. Its most common use in pregnancy is in ventilation-perfusion lung scanning for detection of pulmonary embolism.
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In general, these procedures result in an embryonic or fetal exposure of less than 5 mGy, which is considered a safe dose in pregnancy. The half-life of this radioisotope is 6 hours, and it is a pure gamma ray emitter, which minimizes the dose of radiation without compromising the image 9. All these facts support the safety of technetium 99m at 5 mGy when indicated during pregnancy. Not all radioisotopes can be used safely during pregnancy.
Radioactive iodine iodine readily crosses the placenta, has a half-life of 8 days, and can adversely affect the fetal thyroid, especially if used after weeks of gestation 9. Whether for diagnostic or therapeutic treatment purposes, iodine should not be used during pregnancy.
If a diagnostic scan of the thyroid is essential, technetium 99m is the isotope of choice. Radionuclide compounds are excreted into breast milk in varying concentrations and for varying periods of time.
Method for Estimating Due Date; DE OBGYN Resident Lecture Series with James Manley
In addition, rates of excretion of the same compound can vary between patients. Because some specific nuclear materials excreted into breast milk can have deleterious effects, consultation with experts on breast-feeding and nuclear medicine are recommended when these compounds are used in lactating women.
All rights reserved. No part of this publication may be reproduced, stored in a retrieval system, posted on the Internet, or transmitted, in any form or by any means, electronic, mechanical, photocopying, recording, or otherwise, without prior written permission from the publisher.
Guidelines for diagnostic imaging during pregnancy and lactation. Committee Opinion No.
Dec 01, Post-term pregnancy is defined as a pregnancy that has extended to or beyond 42 weeks of gestation. The American College of Obstetricians and Gynecologists (ACOG. Acog practice bulletin pregnancy dating - Rich woman looking for older man & younger woman. I'm laid back and get along with everyone. Looking for an old soul like myself. I'm a lady. My interests include staying up late and taking naps. Register and search over 40 million singles: matches and more. Join the leader in relations services and find a date today. However, ultrasound dating, in particular first trimester sonography, has greatly improved our ability to calculate the estimated due date (EDD). There will be times that dating based on LMP does not match the ultrasound date. ACOG recommends redating as follows: First trimester: based on CRL measurement 8w6d or less: redate if discrepancy is > 5d.
American College of Obstetricians and Gynecologists. Obstet Gynecol ;e This information is designed as an educational resource to aid clinicians in providing obstetric and gynecologic care, and use of this information is voluntary.
This information should not be considered as inclusive of all proper treatments or methods of care or as a statement of the standard of care.
ABSTRACT: Accurate dating of pregnancy is important to improve outcomes and is a research and public health imperative. As soon as data from the last menstrual period, the first accurate ultrasound examination, or both are obtained, the gestational age and the estimated due date (EDD) should be determined, discussed with the patient, and documented clearly in the medical record. Introduction. Imaging studies are important adjuncts in the diagnostic evaluation of acute and chronic conditions. The use of X-ray, ultrasonography, CT, nuclear medicine, and MRI has become so ingrained in the culture of medicine, and their applications are so diverse, that women with recognized or unrecognized pregnancy are likely to be evaluated with any one of these modalities 1. A free pregnancy calculator to calculate your due date. Use your LMP and cycle length in our pregnancy calculator to discover your own pregnancy calendar.
It is not intended to substitute for - keitaiplus.com professional judgment of the treating clinician. Variations in practice may be warranted when, in the reasonable judgment of the treating clinician, such course of action is indicated by the condition of the patient, limitations of available resources, or advances in knowledge or technology.
The American College of Obstetricians and Gynecologists reviews its publications regularly; however, its publications may not reflect the most recent evidence.
HCG (Human Chorionic Gonadotropin) is often called the pregnancy hormone because it is made by cells formed in the placenta, which nourishes the egg after it has been fertilized and becomes attached to the uterine wall. Levels can first be detected by a blood test about 11 days after conception and about days after conception by a urine test. Redating a pregnancy may occur when there is a discrepancy between the estimated due date (EDD) calculated by the last menstrual period (LMP) and that by ultrasound. Care should be taken when redating a pregnancy, especially in the third trimester, as there may be other reasons for a fetus to be small for gestational age (e.g. intrauterine growth restriction). A pelvic examination supported by good menstrual records in the first trimester has been reported to be a reliable method for dating of pregnancy . Doppler Ultrasonography The fetal heart can be heard using Doppler ultrasound by 10 to 12 weeks in most patients .
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Neither ACOG nor its officers, directors, members, employees, or agents will be liable for any loss, damage, or claim with respect to any liabilities, including direct, special, indirect, or consequential damages, incurred in connection with this publication or reliance on the information presented. Bulk pricing was not found for item.
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