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Semin intervent Radiol 2024; 41(04): 413-423
DOI: 10.1055/s-0044-1790559
Clinical Corner

Obstetric Interventional Radiology: Periprocedural Considerations When Caring for the Pregnant and Postpartum Patient

Nicole Keefe
1   Department of Radiology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
,
Naishal Patel
2   Department of Surgery, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
,
Priya Mody
1   Department of Radiology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
,
Kathleen Smith
3   Department of Anesthesia, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
,
Johanna Quist-Nelson
4   Department of Obstetrics and Gynecology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
,
Claire Kaufman
5   Department of Interventional Radiology, Oregon Health and Science University, Portland, Oregon
,
Maureen Kohi
1   Department of Radiology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
,
Gloria Salazar
1   Department of Radiology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
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Interventional radiology (IR) has had a growing role in the care of pregnant patients over the past few decades. IR is involved in ∼15 per 100,000 pregnancies for the treatment of the placenta accreta spectrum, although there is a variety of procedures that interventional radiologists may perform on a pregnant patient.[1] Caring for this population in the interventional radiology suite can be difficult; positioning considerations, physiological changes, and radiation protection for the mother and fetus pose unique challenges. The aim of this review is to concisely summarize current evidence regarding periprocedural care for pregnant and breastfeeding patients and to present a framework for planning obstetric interventions. The overall paucity of high-level data within this broad range of topics limits the ability to perform a strong systematic review of the literature and as such, this article serves as a narrative review.



Publication History

Article published online:
07 November 2024

© 2024. Thieme. All rights reserved.

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  • References

  • 1 Baldwin HJ, Randall DA, Maher R. et al. Interventional radiology in obstetric patients: a population-based record linkage study of use and outcomes. Acta Obstet Gynecol Scand 2023; 102 (03) 370-377
    CrossrefPubMedSearch in Google Scholar
  • 2 Siebert D, et al. ACR–SPR practice parameter for imaging pregnant or potentially pregnant patients with ionizing radiation. ACR 2023
    PubMed
  • 3 Lambrecht S, Van De Velde M. Interventional radiology for the obstetric patient. Curr Opin Anaesthesiol 2020; 33 (04) 566-570
    CrossrefPubMedSearch in Google Scholar
  • 4 Zhao H, Wang Q, Han M, Xiao X. Current state of interventional procedures to treat pernicious placenta previa accompanied by placenta accreta spectrum: a review. Medicine (Baltimore) 2023; 102 (37) e34770
    CrossrefPubMedSearch in Google Scholar
  • 5 Neuman G, Koren G. Safety of procedural sedation in pregnancy. J Obstet Gynaecol Can 2013; 35 (02) 168-173
    CrossrefPubMedSearch in Google Scholar
  • 6 Humphries A, Mirjalili SA, Tarr GP, Thompson JMD, Stone P. The effect of supine positioning on maternal hemodynamics during late pregnancy. J Matern Fetal Neonatal Med 2019; 32 (23) 3923-3930
    CrossrefPubMedSearch in Google Scholar
  • 7 Guérin C, Reignier J, Richard JC. et al; PROSEVA Study Group. Prone positioning in severe acute respiratory distress syndrome. N Engl J Med 2013; 368 (23) 2159-2168
    CrossrefPubMedSearch in Google Scholar
  • 8 Tolcher MC, McKinney JR, Eppes CS. et al. Prone positioning for pregnant women with hypoxemia due to coronavirus disease 2019 (COVID-19). Obstet Gynecol 2020; 136 (02) 259-261
    CrossrefPubMedSearch in Google Scholar
  • 9 Samanta S, Samanta S, Wig J, Baronia AK. How safe is the prone position in acute respiratory distress syndrome at late pregnancy?. Am J Emerg Med 2014; 32 (06) 687.e1-687.e3
    CrossrefPubMedSearch in Google Scholar
  • 10 Primrose A, Roy N, Teo M, Kanagalingam M. Prone positioning of pregnant patients for lumbar spinal surgery. Anaesth Cases 2014; 2: 103-106
    CrossrefPubMedSearch in Google Scholar
  • 11 Osmundo Jr GS, Paganotti CF, da Costa RA. et al. Prone positioning: a safe and effective procedure in pregnant women presenting with severe acute respiratory distress syndrome. Vaccines (Basel) 2022; 10 (12) 2182
    CrossrefPubMedSearch in Google Scholar
  • 12 Dennis AT, Hardy L, Leeton L. The prone position in healthy pregnant women and in women with preeclampsia - a pilot study. BMC Pregnancy Childbirth 2018; 18 (01) 445
    CrossrefPubMedSearch in Google Scholar
  • 13 Kim FJ, da Silva RD, Gustafson D, Nogueira L, Harlin T, Paul DL. Current issues in patient safety in surgery: a review. Patient Saf Surg 2015; 9: 26
    CrossrefPubMedSearch in Google Scholar
  • 14 Practice Guidelines for Moderate Procedural Sedation and Analgesia. Practice Guidelines for Moderate Procedural Sedation and Analgesia 2018: A Report by the American Society of Anesthesiologists Task Force on Moderate Procedural Sedation and Analgesia, the American Association of Oral and Maxillofacial Surgeons, American College of Radiology, American Dental Association, American Society of Dentist Anesthesiologists, and Society of Interventional Radiology. Anesthesiology 2018; 128 (03) 437-479
    CrossrefPubMedSearch in Google Scholar
  • 15 ACOG Committee Opinion No. ACOG Committee Opinion No. 775: Nonobstetric surgery during pregnancy. Obstet Gynecol 2019; 133 (04) e285-e286
    CrossrefPubMedSearch in Google Scholar
  • 16 Kacmar R, Gaiser R. Physiologic changes of pregnancy. In: Chestnut's Obstetric Anesthesia Principles and Practice. Elsevier; 2020: 19-22
    Search in Google Scholar
  • 17 Food and Drug Administration. Content and Format of Labeling for Human Prescription Drug and Biological Products; Requirements for Pregnancy and Lactation Labeling. Published online December 4, 2014. Accessed June 11, 2024 at: http://federalregister.gov/a/2014-28241
    PubMed
  • 18 Bouvet L, Schulz T, Piana F, Desgranges F-P, Chassard D. Pregnancy and labor epidural effects on gastric emptying: a prospective comparative study. Anesthesiology 2022; 136 (04) 542-550
    CrossrefPubMedSearch in Google Scholar
  • 19 Reale SC, Bauer ME, Klumpner TT. et al; Multicenter Perioperative Outcomes Group Collaborators. Frequency and risk factors for difficult intubation in women undergoing general anesthesia for cesarean delivery: a multicenter retrospective cohort analysis. Anesthesiology 2022; 136 (05) 697-708
    CrossrefPubMedSearch in Google Scholar
  • 20 Cleary EM, Smid MC, Bokat C, Costantine MM, Rood KM. Indicated opioids in pregnancy: guidance on providing comprehensive care. Am J Perinatol 2023; 40 (06) 602-611
    Thieme ConnectPubMedSearch in Google Scholar
  • 21 Pacheco LD, Saade GR, Hankins GDV. Mechanical ventilation during pregnancy. Clin Obstet Gynecol 2014; 57: 844-850
    CrossrefPubMedSearch in Google Scholar
  • 22 Enato E, Moretti M, Koren G. The fetal safety of benzodiazepines: an updated meta-analysis. J Obstet Gynaecol Can 2011; 33 (01) 46-48
    CrossrefPubMedSearch in Google Scholar
  • 23 Dolovich LR, Addis A, Vaillancourt JM, Power JD, Koren G, Einarson TR. Benzodiazepine use in pregnancy and major malformations or oral cleft: meta-analysis of cohort and case-control studies. BMJ 1998; 317 (7162) 839-843
    CrossrefPubMedSearch in Google Scholar
  • 24 Roberti R, Rocca M, Iannone LF. et al. Status epilepticus in pregnancy: a literature review and a protocol proposal. Expert Rev Neurother 2022; 22 (04) 301-312
    CrossrefPubMedSearch in Google Scholar
  • 25 Shin J. Anesthetic management of the pregnant patient: Part 2. Anesth Prog 2021; 68 (02) 119-127
    CrossrefPubMedSearch in Google Scholar
  • 26 Chehab MA, Thakor AS, Tulin-Silver S. et al. Adult and pediatric antibiotic prophylaxis during vascular and IR procedures: a Society of Interventional Radiology Practice Parameter Update Endorsed by the Cardiovascular and Interventional Radiological Society of Europe and the Canadian Association for Interventional Radiology. J Vasc Interv Radiol 2018; 29 (11) 1483-1501.e2
    CrossrefPubMedSearch in Google Scholar
  • 27 Bookstaver PB, Bland CM, Griffin B, Stover KR, Eiland LS, McLaughlin M. A review of antibiotic use in pregnancy. Pharmacotherapy 2015; 35 (11) 1052-1062
    CrossrefPubMedSearch in Google Scholar
  • 28 Lamont HF, Blogg HJ, Lamont RF. Safety of antimicrobial treatment during pregnancy: a current review of resistance, immunomodulation and teratogenicity. Expert Opin Drug Saf 2014; 13 (12) 1569-1581
    CrossrefPubMedSearch in Google Scholar
  • 29 Li Y, Zhang C, Huang X, Tang J. Effect of antimicrobial exposure in pregnancy on adverse pregnancy outcomes and admission rate to the neonatal intensive care unit: a multi-center cohort study. Infect Drug Resist 2023; 16: 2441-2451
    CrossrefPubMedSearch in Google Scholar
  • 30 Chow AW, Jewesson PJ. Pharmacokinetics and safety of antimicrobial agents during pregnancy. Rev Infect Dis 1985; 7 (03) 287-313
    CrossrefPubMedSearch in Google Scholar
  • 31 Yefet E, Salim R, Chazan B, Akel H, Romano S, Nachum Z. The safety of quinolones in pregnancy. Obstet Gynecol Surv 2014; 69 (11) 681-694
    CrossrefPubMedSearch in Google Scholar
  • 32 Briggs GGFR. Drugs in Pregnancy and Lactation. Baltimore, MD:: Williams and Wilkins; 2014
    Search in Google Scholar
  • 33 Heikkilä AM. Antibiotics in pregnancy – a prospective cohort study on the policy of antibiotic prescription. Ann Med 1993; 25 (05) 467-471
    CrossrefPubMedSearch in Google Scholar
  • 34 Mylonas I. Antibiotic chemotherapy during pregnancy and lactation period: aspects for consideration. Arch Gynecol Obstet 2011; 283 (01) 7-18
    CrossrefPubMedSearch in Google Scholar
  • 35 Erić M, Sabo A. Teratogenicity of antibacterial agents. Coll Antropol 2008; 32 (03) 919-925
    PubMedSearch in Google Scholar
  • 36 Subtil D, Brabant G, Tilloy E. et al. Early clindamycin for bacterial vaginosis in pregnancy (PREMEVA): a multicentre, double-blind, randomised controlled trial. Lancet 2018; 392 (10160): 2171-2179
    CrossrefPubMedSearch in Google Scholar
  • 37 Briggs GG, Towers CV, Forinash AB. Drugs in Pregnancy and Lactation: A Reference Guide to Fetal and Neonatal Risk. 12th ed. Philadelphia, PA: Lippincott Williams & Wilkins; 2021
    Search in Google Scholar
  • 38 Committee on Practice Bulletins-Obstetrics. ACOG Practice Bulletin No. 189: Nausea and vomiting of pregnancy. Obstet Gynecol 2018; 131 (01) e15-e30
    CrossrefPubMedSearch in Google Scholar
  • 39 Abas MN, Tan PC, Azmi N, Omar SZ. Ondansetron compared with metoclopramide for hyperemesis gravidarum: a randomized controlled trial. Obstet Gynecol 2014; 123 (06) 1272-1279
    CrossrefPubMedSearch in Google Scholar
  • 40 Matok I, Gorodischer R, Koren G, Sheiner E, Wiznitzer A, Levy A. The safety of metoclopramide use in the first trimester of pregnancy. N Engl J Med 2009; 360 (24) 2528-2535
    CrossrefPubMedSearch in Google Scholar
  • 41 Magee LA, Mazzotta P, Koren G. Evidence-based view of safety and effectiveness of pharmacologic therapy for nausea and vomiting of pregnancy (NVP). Am J Obstet Gynecol 2002; 186 (5, Suppl Understanding): S256-S261
    CrossrefPubMedSearch in Google Scholar
  • 42 Cook JL. Epidemiology of opioid use in pregnancy. Best Pract Res Clin Obstet Gynaecol 2022; 85 (Pt B): 12-17
    CrossrefPubMedSearch in Google Scholar
  • 43 Tillett J, Kostich LM, VandeVusse L. Use of over-the-counter medications during pregnancy. J Perinat Neonatal Nurs 2003; 17 (01) 3-18
    CrossrefPubMedSearch in Google Scholar
  • 44 Choi EY, Jeong HE, Noh Y. et al. Neonatal and maternal adverse outcomes and exposure to nonsteroidal anti-inflammatory drugs during early pregnancy in South Korea: a nationwide cohort study. PLoS Med 2023; 20 (02) e1004183
    CrossrefPubMedSearch in Google Scholar
  • 45 Li DK, Ferber JR, Odouli R, Quesenberry C. Use of nonsteroidal antiinflammatory drugs during pregnancy and the risk of miscarriage. Am J Obstet Gynecol 2018; 219 (03) 275.e1-275.e8
    CrossrefPubMedSearch in Google Scholar
  • 46 Stanley AY, Durham CO, Sterrett JJ, Wallace JB. Safety of over-the-counter medications in pregnancy. MCN Am J Matern Child Nurs 2019; 44 (04) 196-205
    CrossrefPubMedSearch in Google Scholar
  • 47 Bremme KA. Haemostatic changes in pregnancy. Best Pract Res Clin Haematol 2003; 16 (02) 153-168
    CrossrefPubMedSearch in Google Scholar
  • 48 Sultan AA, West J, Tata LJ, Fleming KM, Nelson-Piercy C, Grainge MJ. Risk of first venous thromboembolism in and around pregnancy: a population-based cohort study. Br J Haematol 2012; 156 (03) 366-373
    CrossrefPubMedSearch in Google Scholar
  • 49 Greer IA, Nelson-Piercy C. Low-molecular-weight heparins for thromboprophylaxis and treatment of venous thromboembolism in pregnancy: a systematic review of safety and efficacy. Blood 2005; 106 (02) 401-407
    CrossrefPubMedSearch in Google Scholar
  • 50 Scheres LJJ, Bistervels IM, Middeldorp S. Everything the clinician needs to know about evidence-based anticoagulation in pregnancy. Blood Rev 2019; 33: 82-97
    CrossrefPubMedSearch in Google Scholar
  • 51 Brancazio LR, Roperti KA, Stierer R, Laifer SA. Pharmacokinetics and pharmacodynamics of subcutaneous heparin during the early third trimester of pregnancy. Am J Obstet Gynecol 1995; 173 (04) 1240-1245
    CrossrefPubMedSearch in Google Scholar
  • 52 American Association of Physicists in Medicine. ( 2019 AAPM position statement on the use of patient gonadal and fetal shielding. Accessed November 5, 2022 at: https://www.aapm.org/org/policies/details.asp?id=2552&type=PS
    PubMedSearch in Google Scholar
  • 53 Beyer-Westendorf J, Michalski F, Tittl L. et al. Pregnancy outcome in patients exposed to direct oral anticoagulants - and the challenge of event reporting. Thromb Haemost 2016; 116 (04) 651-658
    PubMedSearch in Google Scholar
  • 54 American College of Obstetricians and Gynecologists' Committee on Practice Bulletins—Obstetrics. 196: Thromboembolism in Pregnancy. Obstet Gynecol 2018; 132 (01) e1-e17
    CrossrefPubMedSearch in Google Scholar
  • 55 Leonhardt G, Gaul C, Nietsch HH, Buerke M, Schleussner E. Thrombolytic therapy in pregnancy. J Thromb Thrombolysis 2006; 21 (03) 271-276
    CrossrefPubMedSearch in Google Scholar
  • 56 Sattari M, Serwint JR, Levine DM. Maternal implications of breastfeeding: a review for the internist. Am J Med 2019; 132 (08) 912-920
    CrossrefPubMedSearch in Google Scholar
  • 57 Mitchell J, Jones W, Winkley E, Kinsella SM. Guideline on anaesthesia and sedation in breastfeeding women 2020: Guideline from the Association of Anaesthetists. Anaesthesia 2020; 75 (11) 1482-1493
    CrossrefPubMedSearch in Google Scholar
  • 58 Reece-Stremtan S, Campos M, Kokajko L. Academy of Breastfeeding Medicine. ABM Clinical Protocol #15: Analgesia and anesthesia for the breastfeeding mother, revised 2017. Breastfeed Med 2017; 12 (09) 500-506
    CrossrefPubMedSearch in Google Scholar
  • 59 Anderson PO. Anticoagulants and breastfeeding. Breastfeed Med 2017; 12: 77-78
    CrossrefPubMedSearch in Google Scholar
  • 60 National Institute of Child Health and Human Development.. Drugs and Lactation Database (LactMed®). Bethesda, MD:: National Institute of Child Health and Human Development; 2006
    Search in Google Scholar
  • 61 Tremblay E, Thérasse E, Thomassin-Naggara I, Trop I. Quality initiatives: guidelines for use of medical imaging during pregnancy and lactation. Radiographics 2012; 32 (03) 897-911
    CrossrefPubMedSearch in Google Scholar
  • 62 Beckett KR, Moriarity AK, Langer JM. Safe use of contrast media: what the radiologist needs to know. Radiographics 2015; 35 (06) 1738-1750
    CrossrefPubMedSearch in Google Scholar
  • 63 Cova MA, Stacul F, Quaranta R. et al. Radiological contrast media in the breastfeeding woman: a position paper of the Italian Society of Radiology (SIRM), the Italian Society of Paediatrics (SIP), the Italian Society of Neonatology (SIN) and the Task Force on Breastfeeding, Ministry of Health, Italy. Eur Radiol 2014; 24 (08) 2012-2022
    CrossrefPubMedSearch in Google Scholar
  • 64 ACR Committee on Drugs and Contrast Media. ACR Manual on Contrast Media. https://www.acr.org/-/media/acr/files/clinical-resources/contrast_media.pdf
    PubMed
  • 65 The Application of ALARA for Occupational Exposures. NCRP Statement No. 8, Issued June 8, 1999. National Council on Radiation Protection. Health Phys 2000; 78: 28-29
    CrossrefPubMedSearch in Google Scholar
  • 66 McCollough CH, Schueler BA, Atwell TD. et al. Radiation exposure and pregnancy: when should we be concerned?. Radiographics 2007; 27 (04) 909-917 , discussion 917–918
    CrossrefPubMedSearch in Google Scholar
  • 67 ACOG Committee Opinion #299: Guidelines for diagnostic imaging during pregnancy. Obstet Gynecol 2004; 104: 647
    CrossrefPubMedSearch in Google Scholar
  • 68 Dauer LT, Thornton RH, Miller DL. et al; Society of Interventional Radiology Safety and Health Committee, Cardiovascular and Interventional Radiology Society of Europe Standards of Practice Committee. Radiation management for interventions using fluoroscopic or computed tomographic guidance during pregnancy: a joint guideline of the Society of Interventional Radiology and the Cardiovascular and Interventional Radiological Society of Europe with Endorsement by the Canadian Interventional Radiology Association. J Vasc Interv Radiol 2012; 23 (01) 19-32
    CrossrefPubMedSearch in Google Scholar
  • 69 Osei EK, Faulkner K. Fetal doses from radiological examinations. Br J Radiol 1999; Aug; 72 (860) 773-780 . PMID: 10624343
    CrossrefPubMedSearch in Google Scholar
  • 70 Huda W. Review of Radiologic Physics. Philadelphia, PA:: Lippincott Williams & Wilkins;; 2009
    Search in Google Scholar
  • 71 Wakeford R, Tawn EJ. The meaning of low dose and low dose-rate. J Radiol Prot 2010; 30 (01) 1-3
    CrossrefPubMedSearch in Google Scholar