Most common non-OB surgical condition Fetal loss >30% if ruptured,
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Transcript of Most common non-OB surgical condition Fetal loss >30% if ruptured,
• Most common non-OB surgical condition
• Fetal loss >30% if ruptured, <2% if not
• Difficult clinical diagnosis:• Majority of cases afebrile
• Physiologic increase WBC6-16,000 & up to 30,000 in labor
• N/V common in pregnancy
• Site of pain may be unusual
APPENDICITIS
Ax T1w: normal appendix
MR SAFETYRECOMMENDATIONS
• No known adverse fetal effects• Safety concern: energy deposition• MR only if US not adequate • Depending on risk/benefit:
• Avoid MR in first trimester• Avoid Gadolinium
(FDA pregnancy category C)
Preparation & Positioning
• NPO x 4 hours
• Supine or decubitus position• LLD: better for IVC compression
• Phased array coil• Large patient: 2 phased array or body coil
Maternal MR: Technique
• 3 plane 6mm T2w HASTE (Seimens) or SSFSE (GE)
• Coronal, axial T2/T1w True-FISP
• Review to determine need for additional sequences or gadolinium
Additional Noncontrast Sequences
• Fat-suppressed T2w• Inflammation, especially if no gad
• T1w or fat-suppressed T1w• Blood products, fat vs. blood, endometriosis
• Thick slab T2w echo train spin echo• MRCP, MR Urography
• Phase contrast/time of flight: vascular
• Dynamic imaging if neededVascular tumor, accreta
• Delayed fat-suppressed T1WInfection, inflammation
Gadolinium
APPENDIX ON MR
Appendix seen in 10/12 pregnant patients with suspected appendicitis(AJR 2004;183:671-5)
Thin slices and cross-referencing tool helpful
Fibroids & Pregnancy
• Pain during pregnancy can be severe• Rapid growth
• Degeneration
• Torsion
• Degeneration may lead to premature labor
SMALL BOWEL OBSTRUCTION
• Adhesions > volvulus >> other causes
• High incidence of necrotic bowel
• Fetal mortality 20-26%• Only 1/3 complete to term after surgery
• Most significant contributor to mortality: delayed diagnosis and treatment
• MR: Ultra-fast sequences (HASTE, FISP) helpful due to minimal motion artifact
• Pregnant women predisposed to torsion
• Ultrasound diagnostic unless ovaries poorly visualized due to pregnancy
• MR appearance: enlarged ovary with increased stromal SI on T2w
• Increased SI on T1w suggests hemorrhage or vascular congestion
• Gadolinium may be diagnostic
OVARIAN TORSION