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1、The American College ofObstetricians and GynecologistsWOMENS HEALTH CARE PHYSICIANSCOMMITTEE OPINIONNumber 656 February 2016(Replaces Committee Opinion Number 299, September 2004)Committee on Obstetric PracticeThis document is endorsed by the American College of Radiology and the American Institute
2、of Ultrasound in Medicine. This Committee Opinion was developed by the American College of Obstetricians and Gynecologists Committee on Obstetric Practice. Member contributors included Joshua Copel, MD; Yasser El-Sayed, MD; R. Phillips Heine, MD; and Kurt R. Wharton, MD. This document reflects emerg
3、ing clinical and scientific advances as of the date issued and is subject to change. The information should not be construed as dictating an exclusive course of treatment or procedure to be followed.Guidelines for Diagnostic Imaging During Pregnancy and LactationABSTRACT: Imaging studies are importa
4、nt adjuncts in the diagnostic evaluation of acute and chronic condi-tions. However, confusion about the safety of these modalities for pregnant and lactating women and their infants often results in unnecessary avoidance of useful diagnostic tests or the unnecessary interruption of breastfeeding. Ul
5、trasonography and magnetic resonance imaging are not associated with risk and are the imaging techniques of choice for the pregnant patient, but they should be used prudently and only when use is expected to answer a relevant clinical question or otherwise provide medical benefit to the patient. Wit
6、h few exceptions, radiation exposure through radiography, computed tomography scan, or nuclear medicine imaging techniques is at a dose much lower than the exposure associated with fetal harm. If these techniques are necessary in addition to ultra-sonography or magnetic resonance imaging or are more
7、 readily available for the diagnosis in question, they should not be withheld from a pregnant patient. Breastfeeding should not be interrupted after gadolinium administration.RecommendationsThe American College of Obstetricians and Gynecologists Committee on Obstetric Practice makes the following re
8、commendations regarding diagnostic imaging proce-dures during pregnancy and lactation: Ultrasonography and magnetic resonance imaging (MRI) are not associated with risk and are the imag-ing techniques of choice for the pregnant patient, but they should be used prudently and only when use is expected
9、 to answer a relevant clinical question or otherwise provide medical benefit to the patient. With few exceptions, radiation exposure through radiography, computed tomography (CT) scan, or nuclear medicine imaging techniques is at a dose much lower than the exposure associated with fetal harm. If the
10、se techniques are necessary in addition to ultrasonography or MRI or are more readily avail-able for the diagnosis in question, they should not be withheld from a pregnant patient. The use of gadolinium contrast with MRI should be limited; it may be used as a contrast agent in a pregnant woman only
11、if it significantly improves diagnostic performance and is expected to improve fetal or maternal outcome. Breastfeeding should not be interrupted after gado-linium administration.IntroductionImaging studies are important adjuncts in the diagnos-tic evaluation of acute and chronic conditions. The use
12、 of X-ray, ultrasonography, CT, nuclear medicine, and MRI has become so ingrained in the culture of medi-cine, and their applications are so diverse, that women with recognized or unrecognized pregnancy are likely to be evaluated with any one of these modalities (1). However, confusion about the saf
13、ety of these modalities for pregnant and lactating women and their infants often results in unnecessary avoidance of useful diagnostic testsVOL. 127, NO. 2, FEBRUARY 2016OBSTETRICS & GYNECOLOGYe75or the unnecessary interruption of breastfeeding. This document reviews the available literature on diag
14、nos-tic imaging in pregnancy and lactation. Obstetrician gynecologists and other health care providers caring for pregnant and breastfeeding women in need of diagnostic imaging should weigh the risks of exposure to radiation and contrast agents with the risk of nondiagnosis and worsening of disease.
15、 Planning and coordination with a radiologist often is helpful in modifying technique so as to decrease total radiation dose when ionizing radiation studies are indicated (Table 1).UltrasonographyUltrasound imaging should be performed efficiently and only when clinically indicated to minimize fetal
16、exposure risk using the keeping acoustic output levels As Low As Reasonably Achievable (commonly known as ALARA) principle. Ultrasonography involves the use of sound waves and is not a form of ionizing radiation. There have been no reports of documented adverse fetal effects for diagnostic ultrasonography procedures, including duplex Doppler imaging. The U.S. Food and Drug Administrati
