Stones During Pregnancy: Difference between revisions

Line 43:

=== Imaging ===

* '''Ultrasound~~'''~~

==== Ultrasound ====

** '''Preferred modality in pregnant women'''

* '''Preferred modality in pregnant women'''

** '''If an obstructing calculus cannot be visualized by conventional renal US, transvaginal US can provide imaging of the distal ureter'''

* '''If an obstructing calculus cannot be visualized by conventional renal US, transvaginal US can provide imaging of the distal ureter'''

* '''MRI~~'''~~

** '''Recommended as a second-line imaging test when ultrasonography is nondiagnostic''' (CW12 p2039)

==== MRI ====

** Does not rely on ionizing radiation or contrast medium, making it a potentially attractive tool to evaluate pregnant patients.

* '''Recommended as a second-line imaging test when ultrasonography is nondiagnostic''' (CW12 p2039)

** '''Because MRI does not visualize calcium, stones are seen as filling defects overlying the high signal intensity of urine.'''

* Does not rely on ionizing radiation or contrast medium, making it a potentially attractive tool to evaluate pregnant patients.

** '''Visualization of smaller stones with this technique is difficult'''

* '''Because MRI does not visualize calcium, stones are seen as filling defects overlying the high signal intensity of urine.'''

* '''Limited Intravenous Pyelography (IVP)~~'''~~

* '''Visualization of smaller stones with this technique is difficult'''

** '''Consists of one scout image followed by one plate taken ≈30 minutes after the injection of contrast.'''

*** '''Each plain film exposes the fetus to 0.1-0.2 rads''', much below the threshold of 1.2 rads, at which the risk begins to increase.

==== Limited Intravenous Pyelography (IVP) ====

**** '''Low-dose CT <0.19 rads''' (1.9 mSV; 1 rad = 10 mSV) (online source)

* '''Consists of one scout image followed by one plate taken ≈30 minutes after the injection of contrast.'''

**** '''The total pregnancy exposure should not exceed the American College of Obstetrics and Gynecology (ACOG) recommended maximum of 5 rads''' (2016 AUA Stone Surgery Guidelines)

** '''Each plain film exposes the fetus to 0.1-0.2 rads''', much below the threshold of 1.2 rads, at which the risk begins to increase.

* '''Low-dose CT'''

*** '''Low-dose CT <0.19 rads''' (1.9 mSV; 1 rad = 10 mSV) (online source)

*** '''The total pregnancy exposure should not exceed the American College of Obstetrics and Gynecology (ACOG) recommended maximum of 5 rads''' (2016 AUA Stone Surgery Guidelines)

==== CT ====

*'''Low-dose CT'''

* '''Conventional CT'''

** '''Should be avoided''' during pregnancy due radiation particularly high dose

@@ Line 43: / Line 43: @@
 === Imaging ===
-* '''Ultrasound'''
+==== Ultrasound ====
-** '''Preferred modality in pregnant women'''
+* '''Preferred modality in pregnant women'''
-** '''If an obstructing calculus cannot be visualized by conventional renal US, transvaginal US can provide imaging of the distal ureter'''
+* '''If an obstructing calculus cannot be visualized by conventional renal US, transvaginal US can provide imaging of the distal ureter'''
-* '''MRI'''
-** '''Recommended as a second-line imaging test when ultrasonography is nondiagnostic''' (CW12 p2039)
+==== MRI ====
-** Does not rely on ionizing radiation or contrast medium, making it a potentially attractive tool to evaluate pregnant patients.
+* '''Recommended as a second-line imaging test when ultrasonography is nondiagnostic''' (CW12 p2039)
-** '''Because MRI does not visualize calcium, stones are seen as filling defects overlying the high signal intensity of urine.'''
+* Does not rely on ionizing radiation or contrast medium, making it a potentially attractive tool to evaluate pregnant patients.
-** '''Visualization of smaller stones with this technique is difficult'''
+* '''Because MRI does not visualize calcium, stones are seen as filling defects overlying the high signal intensity of urine.'''
-* '''Limited Intravenous Pyelography (IVP)'''
+* '''Visualization of smaller stones with this technique is difficult'''
-** '''Consists of one scout image followed by one plate taken ≈30 minutes after the injection of contrast.'''
-*** '''Each plain film exposes the fetus to 0.1-0.2 rads''', much below the threshold of 1.2 rads, at which the risk begins to increase.
+==== Limited Intravenous Pyelography (IVP) ====
-**** '''Low-dose CT <0.19 rads''' (1.9 mSV; 1 rad = 10 mSV) (online source)
+* '''Consists of one scout image followed by one plate taken ≈30 minutes after the injection of contrast.'''
-**** '''The total pregnancy exposure should not exceed the American College of Obstetrics and Gynecology (ACOG) recommended maximum of 5 rads''' (2016 AUA Stone Surgery Guidelines)
+** '''Each plain film exposes the fetus to 0.1-0.2 rads''', much below the threshold of 1.2 rads, at which the risk begins to increase.
-* '''Low-dose CT'''
+*** '''Low-dose CT <0.19 rads''' (1.9 mSV; 1 rad = 10 mSV) (online source)
+*** '''The total pregnancy exposure should not exceed the American College of Obstetrics and Gynecology (ACOG) recommended maximum of 5 rads''' (2016 AUA Stone Surgery Guidelines)
+==== CT ====
+*'''Low-dose CT'''
 * '''Conventional CT'''
 ** '''Should be avoided''' during pregnancy due radiation particularly high dose