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210
Ultrasound
The most frequent method of imaging during pregnancy is ultrasound, which is
universally accepted as safe. The primary benets of ultrasound are its portability
and ability to provide real-time, bedside imaging. For these reasons, along with its
safety prole, ultrasound is the primary imaging modality of choice for fetal imag-
ing. Measurements including fetus size and fetal heart rate can be obtained quickly
and safely. Ultrasound is not only useful for evaluating the fetus, but can be very
helpful in diagnosing certain emergent conditions in the mother as well such as
appendicitis, cholecystitis, and ovarian pathology.
Ultrasound has the benet of evaluating structures functionally, anatomically,
and dynamically as the patient’s condition evolves. In addition to static imaging, the
ability to utilize Doppler imaging allows proper evaluation of blood ow in struc-
tures of concern. This is particularly pertinent when evaluating a patient with con-
cern for ovarian torsion. While ultrasound of the ovaries is the modality of choice in
the rst and early second trimester, full visualization of the adnexa can become
challenging in the late second and third trimesters.
Despite its many advantages, ultrasound has some limitations. These limitations
include maternal obesity, operator skill, and image quality [2]. When evaluating the
abdomen of a gravid woman, the uterus and fetus may obstruct the ultrasound
images of the organ of interest, especially later in pregnancy. Furthermore, ultra-
sound is not ideal for hollow viscous imaging such as intestines, pancreatic images,
bone, and neurologic imaging. Ultrasound uses high frequency sound waves to pro-
duce the images. These sound waves do emit heat, and there is a theoretical risk of
causing thermal injury when the acoustic output is too high. Higher acoustic output
is necessary when using spectral Doppler imaging to assess fetal cardiac activity;
therefore, it is recommended to use M-mode to measure fetal heart rate to keep the
thermal index and fetal exposure to as low as reasonably achievable (ALARA prin-
ciple) [3]. Chapter two, Emergency Department Ultrasound in Pregnancy provides
a detailed discussion on the use of point-of-care ultrasound for the ED evaluation of
the pregnant patient.
Computed Tomography
CT is increasingly utilized as an imaging modality in pregnancy and does confer
ionizing radiation [4, 5]. Ionizing radiation has been linked to an increased risk of
malignancy, which has been mostly extrapolated from the after-effects of the atomic
bombings in World War II.Exposure to more than 100mGy of ionizing radiation to
one person has been found to have a correlative relationship with increased malig-
nancy risk; below this level, cancer cannot be correlated with radiation exposure.
Almost all diagnostic medical tests that use ionizing radiation use signicantly less
than 100mGy of radiation.
The estimated radiation dose a fetus receives is dependent on the type of study
being acquired, the proximity of the uterus to the anatomic location of the scan
D. Ladkany and K. Layman
211
plane, patient size, x-ray technique, and whether or not protective mechanisms are
used such as lead covering of the abdomen and pelvis (Table16.1). For example, a
CT of the abdomen and pelvis during pregnancy exposes a fetus to approximately
25 mGy, but a CT angiography of the chest to evaluate for pulmonary emboli
exposes the fetus to only 0.2mGy, and a CT head does not expose the fetus to any
radiation at all [6]. In fact, whenever the fetus is outside the eld of the scanned area
such as in CT scans of the head, cervical spine, or extremities, the radiation dose
delivered to the fetus is negligible [7]. The clinical effects of radiation on a fetus
depends on the age of gestation, and the most vulnerable period is between 8 and
15weeks gestation [8]. The very early stages of pregnancy are somewhat protected
from possible teratogenic exposure due to the totipotent or pluripotent nature of the
cells, which allows the abnormal cells to be replaced by nearby cells. However, dur-
ing the 8-to-15-week period of gestation, radiation levels of greater than 100mGy
may cause fetal demise, intellectual decit, or microcephaly. Before 8weeks, the
fetus is at higher risk of congenital anomalies of the organs, skeleton, or genitals [2]
(Table16.2).
In 2023, the American College of Radiology (ACR) and Society for Pediatric
Radiology (SPR) updated the practice parameter regarding imaging of pregnant
patients with ionizing radiation [9]. CT studies outside of the abdomen and pelvis
such as the head and cervical spine are very low–dose and do not even require
Table 16.1 Fetal radiation doses associated with common radiological examinations [6, 14, 15]
Type of examination
Fetal absorbed dose
(mGy)
a
Very low-dose (<0.1mGy)
Cervical spine X-ray (AP and lateral) <0.001
Any extremity X-ray <0.001
Chest X-ray (two views) 0.0005–0.01
Low-to moderate-dose (0–10mGy)
Radiographs
Thoracic spine X-ray 0.003
Abdominal X-ray 0.1–3
Lumbar spine X-ray 1–10
CT
Head, neck, or extremity CT
b
0–10
Chest CT or CT pulmonary angiography 0.01–0.66
Higher-dose (10–50mGy)
Abdominal CT 1.3–35
Pelvic CT 10–50
Abdomen and pelvis CT 13–25
Aortic angiography of chest, abdomen, and pelvis with or without
contrast agent
6.7–56
Coronary artery angiography 0.1–3
Non-enhanced CT of abdomen and pelvis to evaluate for
nephrolithiasis
10–11
CT computed tomography
a
Fetal dose varies with gestational age, maternal body habitus, and exact acquisition parameters
b
Most authors report fetal dose from head, neck, or extremity CT close to zero (negligible scatter)
16 Emergency Department Management of Obstetric Complication: Imaging…
212
Table 16.2
Effects of gestational age and radiation dose on radiation-induced teratogenesis
Gestational Age
<50mGy 50–100mGy 50–100mGy
>100mGy
Before conception
to 2weeks after
Fertilization
None None Probably none Death of embryo or no
consequence (all or none)
Organogenesis
(2–8weeks)
None None Probably none Possible malformations
increasing in likelihood as
dose increases
8–15weeks None None Uncertain, but
probably too subtle
to be clinically
detectable
Risk of diminished IQ
increasing in frequency
and severity with
increasing dose, risk of
microcephaly
16–25weeks None None None Risk of undetectable IQ
decits
>26weeks None None None None applicable to
diagnostic imaging
Adapted from ACR-SPR Practice Parameter for Imaging Pregnant or Potentially Pregnant Patients
with Ionizing Radiation
Attributable risk of developing cancer is estimated to be 0.4% per 10mGy dose to the fetus
IQ intelligence quotient
pregnancy verication or testing before proceeding. CT imaging that includes the
chest, abdomen, pelvis, or hips does confer higher radiation dose, but still far below
the 100mGy threshold. Most radiographic studies confer less than 20mGy to the
fetus; 20mGy of radiation represents an additional projected lifetime cancer risk of
less than 0.8%. In other words, for a study that confers 20mGy of radiation, it is
more than 99% likely the fetus will be unaffected (negligible risk). When discussing
radiation risks with patients, the ACR practice parameter highlights the importance
of framing the information in a positive manner. The sample consent form proposes
the following language: “The examination might slightly increase the possibility of
cancer later in the child’s life, but the actual potential for a healthy life is very nearly
the same as that of other children in circumstances similar to yours but who are not
provided the benet of this medical examination” [9].
ACOG also supports the use of diagnostic CT imaging if the exposure is less than
50mGy, which does not pose fetal risk [1]. Ultimately, if there is a clinical indica-
tion for imaging a pregnant patient using ionizing radiation in the ED, it should be
done, as appropriate and timely diagnosis and treatment of the mother is the safest
way to protect the fetus.
With regard to the use of contrast for CT, oral contrast agents are not absorbed by
the patient and pose no harm to the fetus. Intravenous iodinated contrast media has
been shown to cross the placenta and can enter the fetal circulation; however, there
is no available data to suggest this harms the fetus. Both ACOG and ACR support
the use of intravenous contrast agents when clinically indicated for patient preg-
nants [1, 9]. It is also safe for patients to continue breastfeeding after receiving
contrast media because only a tiny percentage of iodinated contrast medium is
excreted into the breast milk and absorbed by the infant’s gut (under 0.01%) [10].
D. Ladkany and K. Layman
213
Radiographs
Radiographs or x-ray is another form of radiation imaging that is often employed in
pregnancy and generally considered safe to use as needed. Extremity x-rays pose
negligible risk, chest x-ray exposes mother and fetus to very minimal amounts of
radiation, and even a two-view abdominal X-ray confers only ~0.1–3.0mGy fetal
radiation exposure. Therefore, x-rays may be used when indicated.
Magnetic Resonance Imaging
Magnetic Resonance Imaging (MRI) is a method of imaging which uses a powerful
magnetic eld and radio waves to produce an image based on the energy released
from protons within the body. This form of imaging does not use any radiation, and
therefore the risks during pregnancy are minimal. A theoretical risk of MRI during
pregnancy is in the rst trimester during which organogenesis is occurring, and
acoustic damage is possible to developing neural systems and the possibility for
tissue overheating. There has not been any evidence of actual harm with MRI during
pregnancy, and it is recommended to be used as rst line, even in the rst trimester
over CT imaging if necessary and feasible.
Gadolinium-based contrast agents (GBCAs) are used to enhance MRI images.
GBCAs cross the placenta and are not cleared effectively from fetal circulation
which can result in possible carcinogenesis and growth retardation, as seen in ani-
mal studies [8]. The use of GBCAs in pregnant patients has been controversial. One
retrospective study found there was an increased risk of stillbirth or neonatal death
when patients were exposed to GBCAs at any time during pregnancy [11]. A more
recent study of almost 6000 pregnant patients exposed to MRIs with or without
GBCAs found no elevated risk of stillbirth or neonatal death [12]. Given the unclear
risks to the developing fetus, it is advised that GBCAs only be used if their usage is
considered critical and the potential benets to the patient outweigh the potential
unknown risk to the fetus.
Like intravenous iodinated contrast material, it is considered safe to continue
breastfeeding after receiving GBCAs because only a very small percentage of that
is excreted into the breast milk and absorbed by the infant’s gut (<0.0004%) [10].
Nuclear Medicine Imaging
Nuclear medicine scans use radioisotopes to help produce an image and are
employed frequently to evaluate for coronary artery disease and for pulmonary
emboli. In pregnancy, the risk to the fetus depends on the type of study and radio-
isotope used. One of the most obtained studies in pregnancy is ventilation-perfusion
lung scanning (V/Q scan) to diagnose pulmonary embolism. This study uses the
isotope technetium 99m which confers a low dose exposure to the fetus (<5mGy)
and is considered safe [1]. However, studies that utilize radioactive iodine can be
16 Emergency Department Management of Obstetric Complication: Imaging…
214
very harmful to the fetus. Specically, administration of Iodine 131 can result in
very high fetal thyroid doses and cause total cessation of thyroid function; therefore,
it is absolutely contraindicated in pregnancy. Breastfeeding should also be com-
pletely stopped after administration of Iodine 131 [13].
Interventional Procedures
Interventional radiology is often utilized to help with procedures that may be techni-
cally challenging or high risk such as lumbar puncture, central line or medi-port
placements, or biopsies. Many of these procedures employ ionizing radiation (uo-
roscopy) but some can be done under ultrasound—when possible, it is best to avoid
uoroscopy since it requires multiple X-rays in succession.
Summary
The emergency physician will often be faced with deciding which mode of imaging
is appropriate and necessary for a pregnant patient. Many factors affect this decision
including the stage of pregnancy, the urgency of the diagnosis, and what is being
evaluated. Ultrasound and MRI are the safest imaging modalities to evaluate the
mother and the fetus and are not associated with risk to the pregnancy; however,
gadolinium contrast should be avoided. In many cases ionizing radiation such as CT
is necessary to make an accurate and timely diagnosis, especially in the acute set-
ting of trauma. These tests almost always confer signicantly less radiation than the
dose associated with fetal harm. Necessary diagnostic tests should not be withheld
from a pregnant patient out of concern for possible risk to the fetus.
Key Points
1. Ultrasound is the preferred initial mode of imaging for most diagnoses when
feasible and appropriate, especially in fetal and pelvic imaging.
2. CT imaging with IV iodinated contrast is safe in pregnancy and should be used
rst in certain situations, most notably in trauma.
3. MRI is preferred over CT for most diagnostic purposes during pregnancy; how-
ever, IV gadolinium contrast should be avoided.
4. Ionizing radiation poses a risk of teratogenicity at >100mGy of radiation, and
radiation exposure should be limited during pregnancy. However, almost all
medical imaging uses lower doses of radiation; therefore, fetal exposure is usu-
ally signicantly lower than this threshold and should be used when necessary.
5. In an emergency, the physician should use any imaging necessary to make an
accurate and timely diagnosis to ensure the best outcome for both mother
and fetus.
D. Ladkany and K. Layman
215
References
1. ACOG Committee Opinion 723. Guidelines for diagnostic imaging during pregnancy and lac-
tation. Reafrmed 2021.
https://www.acog.org/clinical/clinical- guidance/committee- opinion/
articles/2017/10/guidelines- for- diagnostic- imaging- during- pregnancy- and- lactation.
2. Baysinger CL.Imaging During Pregnancy. Anesth Analg. 2010;110(3):863–7.
3. American Institute for Ultrasound in Medicine: prudent use and safety of diagnostic ultra-
sound in pregnancy ofcial statement May 19, 2020. https://www.aium.org/resources/
ofcial- statements/view/prudent- use- and- safety- of- diagnostic- ultrasound- in- pregnancy.
4. Albakri AA, Alzahrani MM, Alghamdi SH.Medical imaging in pregnancy: safety, appropriate
utilization, and alternate modalities for imaging pregnant patients. Cureus. 2024;16(2):e54346.
5. Kwan M, Miglioretti E, Marlow EJ, etal. Trends in medical imaging during pregnancy in the
United States and Ontario, Canada, 1996 to 2016. JAMA Netw Open. 2019;2:e197249.
6. McCollough CH, Schueler BA, Atwell TD, etal. Radiation exposure and pregnancy: when
should we be concerned? Radiographics. 2007;27(4):909–17.
7. Bourgioti C, Konidari M, Gourtsoyianni S, etal. Imaging during pregnancy: what the radiolo-
gist needs to know. Diagn Interv Imaging. 2021;102(10):p593–603.
8. Gomes M, Matias A, Macedo F.Risks to the fetus from diagnostic imaging during pregnancy:
review and proposal of a clinical protocol. Pediatr Radiol. 2015;45(13):1916–29.
9. American College of Radiology. ACR–SPR practice parameter for imaging pregnant or poten-
tially pregnant patients with ionizing radiation, 2023. Available at:
https://www.acr.org/- /
media/ACR/Files/Practice- Parameters/Pregnant- Pts.pdf.
10. ACR American College of Radiology. ACR manual on contrast media. ACR Committee on
Drugs and Contrast Media; 2024.
11. Ray JG, Vermeulen MJ, Bharatha A, Montanera WJ, Park AL.Association between MRI expo-
sure during pregnancy and fetal and childhood outcomes. JAMA. 2016;316:952–61.
12. Winterstein AG, Thai TN, Nduaguba S, etal. Risk of fetal or neonatal death or neonatal inten-
sive care unit admission associated with gadolinium magnetic resonance imaging exposure
during pregnancy. Am J Obstet Gynecol. 2023;228(4):465.e1–465.e11.
13. Mattsson S, Leide-Svegborn S, Andersson M.X-ray and molecular imaging during pregnancy
and breastfeeding–when should we be worried? Radiat Prot Dosim. 2021;195(3–4):339–48.
14. Tirada N, Dreizin D, Khati NJ, etal. Imaging pregnant and lactating patients. Radiographics.
2015;55:691–6.
15. Tremblay E, Therasse E, Thomassin-Naggara I, etal. Quality initiatives: guidelines for the use
of medical imaging during pregnancy and lactation. Radiographics. 2012;32:897–911.
16 Emergency Department Management of Obstetric Complication: Imaging…
217
© The Editor(s) (if applicable) and The Author(s), under exclusive license to Springer
Nature Switzerland AG 2025
J. Borhart (ed.), Emergency Department Management of Obstetric
Complications, https://doi.org/10.1007/978-3-032-10261-4
A
Abdominal pain in pregnancy, see
Nonobstetric abdominal pain,
in pregnancy
Abruptio placenta, 182
See also Placental abruption
Acquired bleeding disorders, 106
Acute pancreatitis, 192
Acute respiratory distress syndrome
(ARDS), 160
Adnexal mass, 196, 197
Advanced trauma life support (ATLS), 172,
175, 178
Airway management, 163–164
American College of Obstetricians and
Gynecologists (ACOG),
57, 59, 61, 66
Amniotic uid embolism (AFE), 128, 160,
161, 165, 182
Amniotic uid index (AFI), 73
Anoxic brain injury, 161, 165
Antepartum hemorrhage
causes, 45, 52
denition, 45
emergency department evaluation, 45–46
placenta previa, 46–48
placental abruption, 48–50
uterine rupture, 51, 52
vasa previa, 50, 51
Aortic dissection, 150–152
Aortocaval compression, 162–164, 167
Appendicitis, 190–191, 193, 201
As low as reasonably achievable (ALARA
principle), 29
Assisted reproductive technology (ART),
2, 7, 11–12
ectopic pregnancy
incidence, 138
management, 139
heterotopic pregnancy
incidence, 138
management, 139
OHSS, 134–137
ovarian torsion, 137
procedural complications, 134
risk of, 138–139
steps, 133
Associated shock syndrome, 103
B
Balloon tamponade, 107–109
Bimanual compression, 102
Bimanual uterine compression, 106
Bimanual uterine massage, 102, 103
Biparietal diameter (BPD), 28, 29
Bleeding after 20 weeks, see Antepartum
hemorrhage
Blunt trauma, 171, 182
B-Lynch procedure, 110
Bowel obstruction, 190, 193
Brain natriuretic peptide (BNP), 154
Branching milk ducts, 118
Breast abscess, 118–121
Breastfeeding mastitis, 118
Breast inammation, 118
Breech delivery, 83, 92, 93, 95
Breech presentation, 87, 92
C
Cardiac activity, 29
Cardiac arrest
airway management, 163–164
Index
218
Cardiac arrest (cont.)
epidemiology, 159
etiology, 160–162
patient positioning, 162–163
post-resuscitation care, 167
resuscitation techniques, 162
resuscitative hysterotomy, 164–165
Cardiac cycles, 29
Cardiovascular emergencies
aortic dissection, 150–152
deep venous thrombosis, 144
peripartum cardiomyopathy, 152–154
pulmonary embolism, 145, 146, 148, 149
VTE, 143, 144
Cervical insufciency, 76
Cervical lacerations, 127
Cholecystitis, 191, 192
Cholelithiasis, 191, 192
Chorioamnionitis, 74, 75, 78
Chronic hypertension, 58, 59, 66
Complete miscarriage, 9
Computed tomographic pulmonary angiogram
(CTPA), 145, 146, 148, 149
Computed tomography (CT),
in pregnancy, 209–214
Concealed abruptions, 48
Constipation, 195
Consumptive coagulopathy, 160
Continuous cardiotocography (CTG), 183–184
Control of blood pressure, 60–62
Corpus luteum cysts, 7
Crohn’s disease (CD), 194
Crown-rump length (CRL), 27
D
D-dimer test, 106, 145
Deep venous thrombosis (DVT), 143–146,
148, 149
Desmopressin (DDAVP), 108
Discriminatory zone, 4, 5
Disposition
HDP, 62–64
nausea and vomiting in pregnancy, 40–41
preterm labor, 79
trauma, in pregnancy
continuous cardiotocography, 183–184
pain management, 184
Disseminated intravascular coagulation (DIC),
105, 106, 110, 160
Diverticulitis, 193
Diverticulosis, 193
Dopamine antagonists,
37
Ductal microbiomes, 118
Dystocia, 83, 87–92
E
Early pregnancy loss, 8–10
Eclampsia, 58–65
Eclamptic seizures, 58
Ectopic pregnancy, 2–6, 128
ART
incidence, 138
management, 139
β-HCG discriminatory zone, 4
β-hCG level, 4–6
clinical presentations, 2
denition, 2
diagnostic approach, 3, 4
emergency department ultrasound, 25–26
hemodynamically stable patients, 5
imaging, 3–5
incidence, 2
mechanisms, 2
methotrexate treatment protocols, 6
occurrence, 2
traditional operative approach, 5
Emergency department evaluation, 45–46
Emergency department ultrasound
ectopic pregnancy, 25–26
fetal biometry, 29–30
fetal gestational dating, 27–29
intrauterine pregnancy, 24–25
point-of-care ultrasound, 24, 27
pregnancy of unknown location, 26–27
TAUS, 17–20
TVUS, 17, 20–23
Emergency hysterectomy, 110
Emergency Medical Treatment and Active
Labor Act (EMTALA), 64
Endometritis, 105
aerobic and anaerobic organisms, 116
denition, 115
diagnosis of, 116
imaging tests, 116, 117
incidence of, 116
route of delivery, 116
treatment, 117
Episiotomy, 90, 91
Extensive lacerations, 127
Extracorporeal membrane oxygenation
(ECMO), 154, 159, 161, 165, 167
F
Fetal biometry, 29–30
Fetal bradycardia, 29
Fetal cardiac activity, 29
Fetal distress, 160
Fetal bronectin (FFN), 73
Fetal gestational dating, 27–29
Index
219
Fetal hypoxia, 176, 179
Fetal radiation doses associated with
examination, 211
Fetal tachycardia, 29
Fibroids, 190, 197–198
First trimester pregnancy, 9, 10
Focused assessment with sonography
in trauma (FAST), 25, 26
G
Gaskin maneuver, 90
Gastroesophageal reux disease (GERD),
190, 195
Gestational age, effects of, 212
Gestational hypertension, 58–60
H
H1 antagonists, 37, 38
HELLP syndrome, 59, 60, 64, 65, 106
Hemodynamic instability, 105
Heroic maneuvers, 91
Heterotopic pregnancy, 7, 8, 25, 134, 138, 139
Hyperemesis gravidarum (HG), 35–38, 40, 41
Hyperstimulated ovary, 12
Hypertensive disorders, 161
Hypertensive disorders of pregnancy (HDP)
classication, 57–60
control of blood pressure, 60–62
diagnostic criteria, 58
disposition, 62–64
eclampsia, 64, 65
evaluation, 60
HELLP, 64, 65
long term outcomes and prevention, 66–67
pathophysiology, 59–60
preeclampsia, 64, 65
chronic hypertension with
superimposed preeclampsia, 66
less than 20 weeks of gestation, 65, 66
postpartum, 64–65
prevalence, 57
seizure prophylaxis and treatment, 60–62
Hypothalamic-pituitary-ovarian feedback
loop, 133
Hypovolemia, 100
I
Iatrogenic cardiac arrest, 162
Immune thrombocytopenic purpura (ITP), 106
Incomplete inversion, 103
Incomplete miscarriage, 9
Induced abortions, 125,
129
Inevitable miscarriage, 9
Infectious mastitis, 119, 120
Inammatory (non-infectious) mastitis, 118
Inammatory bowel disease (IBD), 194, 195
Injury Severity Score (ISS), 172
Internal rotation maneuvers, 89
Interventional radiology, in pregnancy, 214
Intimate partner violence (IPV), 171–173
Intra-aortic balloon pump (IABP), 154
Intrauterine devices (IUD), 2
Intrauterine pregnancy (IUP), 3–5, 7–9,
20, 24–27
In-vitro fertilization (IVF), 134, 138, 139
J
Jada system, 109
K
Kidney stones, 200, 201
L
Labor and delivery (L&D)
unit, 83, 85, 92
Lactational breast abscesses, 120–121
Laparoscopic detorsion, 137
Lateral tilt, 162
Late-trimester bleeding, see Antepartum
hemorrhage
Left uterine displacement (LUD), 162
Leiomyomas, 197
Low-titer O-positive whole blood
(LTOWB), 178
M
Magnesium, 162
Magnetic resonance imaging (MRI),
in pregnancy, 209, 213, 214
Mastitis
breastfeeding, 118
clinical presentation, 118
denition, 118
infectious, 119, 120
lactation, 119
risk factors, 118
subacute, 120
treatment, 119
Maternal cardiac arrest, 161, 163
McRoberts maneuver, 88–91
Medical expulsive therapy (MET), 201
Methylergonovine, 107
Metoclopramide, 38, 39
Index
220
Minor injuries in pregnant trauma
patients, 183
Missed miscarriage, 9
M-mode, 29, 30
Modied Wells score (MWS), 145, 146
Motor vehicle collisions (MVC), 171–173
Multiple enlarged follicles, 12
Myomectomy, 100
N
Nausea and vomiting, pregnancy
complications, 41
diagnosis, 36
disposition algorithm, 40–41
treatment, 36–40
H1 antagonists, 38
metoclopramide, 38
ondansetron, 39, 40
promethazine, 39
pyridoxine with doxylamine, 37
Nipple trauma, 118
Nonobstetric abdominal pain, in pregnancy
appendicitis, 190, 191
bowel obstruction, 193
cholecystitis, 191, 192
cholelithiasis, 191, 192
constipation, 195
diverticulitis, 193
diverticulosis, 193
broids, 197, 198
GERD, 195
inammatory bowel disease, 194
kidney stones, 200, 201
ovarian cysts, 197
ovarian torsion, 196
pancreatitis, 192
peptic ulcer disease, 195
PID, 201, 202
pyelonephritis, 198, 199
round ligament pain, 198
urinary tract infections, 198, 199
Non-pharmacological alternative therapy, 37
Nuclear medicine imaging, in pregnancy,
213, 214
O
Obstetrical hemorrhage, 100
Ondansetron, 38–41
One-handed “pushing” technique, 162–163
Osmotic cervical dilators, 128
Osmotic demyelination syndrome, 41
Ovarian cysts, 197
Ovarian hyperstimulation syndrome (OHSS),
11, 134–137, 139
Ovarian torsion, 134, 137, 196, 197
Oxytocin, 107
P
Pancreatitis, 192
Pathologic contractions, 178
Pelvic infection, 134
Pelvic inammatory disease (PID), 201, 202
Penetrating trauma, 171
Peptic ulcer disease, 195
Perimortem cesarean section, 164–166
Peripartum cardiomyopathy (PPCM),
143, 152–154
Permanent neurologic injury, 87–88
Placenta accreta, 103, 106
Placenta previa, 45–49, 51, 103
Placental abruption, 48–50, 171–174, 179,
182, 183
Placental delivery, 100
Placental site subinvolution, 104
Point-of-care ultrasound, 24, 27
Postabortion complications
delayed, 128, 129
immediate complications
amniotic uid embolism, 128
cervical lacerations, 127
ectopic pregnancy, 128
osmotic cervical dilators, 128
pharmacologic side effects, 126
uterine atony, 127
uterine perforation, 127
vaginal bleeding, 126, 127
management, 126
self-induced abortions, 129
Postpartum complications
endometritis
aerobic and anaerobic organisms, 116
denition, 115
diagnosis of, 116
imaging tests, 116, 117
incidence of, 116
route of delivery, 116
treatment, 117
lactational breast abscesses, 120–121
mastitis
breastfeeding, 118
clinical presentation, 118
denition, 118
infectious, 119, 120
Index