RESPIRATORY

ResponsePulmonary Embolism
Spontaneous pneumothorax
Trauma (including domestic violence)
Costochondritis
Pneumonia
Pleurisy
Amniottic fluid embolism
Preeclampsia/HELLP syndrome
Aortic dissection

GORD/reflux
Biliary/cholestasis/pancreatitis
MSK/Trauam/chest wall

ResponseBalance of diagnosis with high sensitivity vs radiation risk to mother and child
Leg U/S ?DVT - if positive treat
XR, Echo or D dimer not adequate
Wells/PERC not validated in pregnancy
Informed input from patient.

ResponseGood negative predictive value, No radiation, low cost/resources
Can be falsely elevated by pregnancy, false positive sin dissection. Positive results basically “locks in” imaging and associated radiation risk. Reference range in pregnancy unknown

ResponseDVT Doppler

• No radiation, if positive can avoid further scan and initiate treatment
• No use if no exam findings of DVT, Pelvic DVT more common in pregnancy but will be missed

VQ

• Pro - Less breast and thyroid radiation. Good negative and positive predictive values
• Con - variable sensitivity, interpreter dependent. May be more foetal radiation (With bladder accumulation), aviailability, scan is slow, Ideally to have IDC to reduce radiation from bladder

CTPA (Basically more radiation to mothers breasts, less to fetus)

• Pro more availability, better sensitivity, good NPV. Quick. Alternative pathologies shown
• Con: greater radiation risk to mother (Breasts) and child (if 3rd trimester), theoretical risk to foetal thyroid from contrast, allergy to contrast

Radiation - ?newer CT machines less than VQ? Seems that CT is radiation to breasts, VQ is radiation to fetus MRI Angiography is probably going to change things.