It should be axiomatic that a woman must never be penalized because she is pregnant. To ensure this, several questions should be addressed: What management would be recommended if the woman were not pregnant? If the proposed management is different because the woman is pregnant, can this be justified? What are the risks versus benefits to the mother and her fetus, and are they counter to each other? Can an individualized management plan be devised that balances benefits versus risks of any alterations?

1. BY: MUKESH SAH, MD POST GRADUATE MEDICAL INTERN
GENERAL
CONSIDERATIONS AND
MATERNAL EVALUATION

2. Maternal Physiology And Alteration In
Laboratory Values
 Pregnancy induces physiological changes in most organ
systems.
 Some of these are profound and may amplify or obfuscate
evaluation of coexisting conditions.
 Results of laboratory tests can also be altered, and some of
these would, in the no pregnant woman, be considered
abnormal.

3. Medications During Pregnancy
 Antepartum management of nonobsrtetrical disorders
includes administration of various drugs.
 The vast majority necessary to treat the most commonly
encountered complications can be used with relative safety.

4. Surgery During Pregnancy
 Laparoscopy has become the most common first-
trimester procedure used for diagnosis and
management of several surgical disorders
 addition to management of ectopic pregnancy, it is
used preferentially during most of pregnancy for
exploration and treatment of adnexal masses, for
appendectomy, and for cholecystectomy
 There are no randomized trials comparing
laparoscopic with open surgery
 The most frequently performed procedures were
cholecystectomy, adnexal surgery, and
appendectomy

5. physiological effects of co2 insufflation of the peritoneal cavity

6. selected types of surgical procedures by trimester in 3615 women

7. Imaging Techniques
 Ionizing radiation
 Ultrasound
 Magnetic resonance imaging
 Guidelines for diagnostic imaging during
pregnancy

8. Magnetic Resonance ( MR ) Imaging
 MRI – useful tool in both OB/GYN imaging
 No reported harmful human effects from its use, including any
mutagenic effects / no demonstrable fetal heart pattern
changes during imaging
 Indication – any gestational age if no other imaging studies
can be performed

9. Guidelines For Diagnostic Imaging During
Pregnancy
 Woman should be counseled that X – Ray exposure from a
single diagnostic procedure does not result in harmful fetal
effects.
 Concern about possible effects of high – dose ionizing
radiation exposure should not prevent medically indicated
diagnostic X – Ray procedure from being performed on the
mother.

10.  US and MRI are not associated with known
adverse fetal effects
 Consultation with a radiologist may be helpful in
calculating estimated fetal dose when multiple
diagnostic X – Rays are performed on a pregnant
woman
 The use of radioactive isotope of iodine is
contraindicated for therapeutic use during
pregnancy

11. THANK YOU