{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,8]],"date-time":"2026-09-08T17:14:01Z","timestamp":1788887641557,"version":"build-2803163510"},"reference-count":35,"publisher":"MDPI AG","issue":"3","license":[{"start":{"date-parts":[[2024,1,26]],"date-time":"2024-01-26T00:00:00Z","timestamp":1706227200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Diagnostics"],"abstract":"<jats:p>Trauma is the leading non-obstetric cause of maternal and fetal mortality and affects an estimated 5\u20137% of all pregnancies. Pregnant women, thankfully, are a small subset of patients presenting in the trauma bay, but they do have distinctive physiologic and anatomic changes. These increase the risk of certain traumatic injuries, and the gravid uterus can both be the primary site of injury and mask other injuries. The primary focus of the initial management of the pregnant trauma patient should be that of maternal stabilization and treatment since it directly affects the fetal outcome. Diagnostic imaging plays a pivotal role in initial traumatic injury assessment and should not deviate from normal routine in the pregnant patient. Radiographs and focused assessment with sonography in the trauma bay will direct the use of contrast-enhanced computed tomography (CT), which remains the cornerstone to evaluate the potential presence of further management-altering injuries. A thorough understanding of its risks and benefits is paramount, especially in the pregnant patient. However, like any other trauma patient, if evaluation for injury with CT is indicated, it should not be denied to a pregnant trauma patient due to fear of radiation exposure.<\/jats:p>","DOI":"10.3390\/diagnostics14030276","type":"journal-article","created":{"date-parts":[[2024,1,26]],"date-time":"2024-01-26T10:54:27Z","timestamp":1706266467000},"page":"276","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":6,"title":["Initial Imaging of Pregnant Patients in the Trauma Bay\u2014Discussion and Review of Presentations at a Level-1 Trauma Centre"],"prefix":"10.3390","volume":"14","author":[{"given":"Roisin","family":"MacDermott","sequence":"first","affiliation":[{"name":"Department of Medical Imaging, Sunnybrook Health Science Centre, University of Toronto, Toronto, ON M4N 3M5, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3696-2554","authenticated-orcid":false,"given":"Ferco H.","family":"Berger","sequence":"additional","affiliation":[{"name":"Department of Medical Imaging, Sunnybrook Health Science Centre, University of Toronto, Toronto, ON M4N 3M5, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrea","family":"Phillips","sequence":"additional","affiliation":[{"name":"Tory Trauma Program, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON M4N 3M5, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jason A.","family":"Robins","sequence":"additional","affiliation":[{"name":"Department of Medical Imaging, Sunnybrook Health Science Centre, University of Toronto, Toronto, ON M4N 3M5, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael E.","family":"O\u2019Keeffe","sequence":"additional","affiliation":[{"name":"Department of Medical Imaging, Sunnybrook Health Science Centre, University of Toronto, Toronto, ON M4N 3M5, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9494-2925","authenticated-orcid":false,"given":"Rawan Abu","family":"Mughli","sequence":"additional","affiliation":[{"name":"Department of Medical Imaging, Sunnybrook Health Science Centre, University of Toronto, Toronto, ON M4N 3M5, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0001-8747-6436","authenticated-orcid":false,"given":"David B.","family":"MacLean","sequence":"additional","affiliation":[{"name":"Department of Anesthesia, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON M4N 3M5, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Grace","family":"Liu","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON M4N 3M5, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Heather","family":"Heipel","sequence":"additional","affiliation":[{"name":"Department of Medicine (Emergency Medicine), Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON M4N 3M5, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Avery B.","family":"Nathens","sequence":"additional","affiliation":[{"name":"Tory Trauma Program, Department of Surgery, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON M4N 3M5, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6637-6092","authenticated-orcid":false,"given":"Sadia Raheez","family":"Qamar","sequence":"additional","affiliation":[{"name":"Department of Medical Imaging, Sunnybrook Health Science Centre, University of Toronto, Toronto, ON M4N 3M5, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2024,1,26]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"553","DOI":"10.1016\/S1701-2163(15)30232-2","article-title":"Guidelines for the Management of a Pregnant Trauma Patient","volume":"37","author":"Jain","year":"2015","journal-title":"J. Obs. Gynaecol. Can."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"S385","DOI":"10.1097\/01.CCM.0000182808.99433.55","article-title":"Trauma in pregnanty","volume":"33","author":"Mattox","year":"2005","journal-title":"Crit. Care Med."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"590.e1","DOI":"10.1016\/j.ajog.2017.08.004","article-title":"Pregnant trauma victims experience nearly 2-fold higher mortality compared to their nonpregnant counterparts","volume":"217","author":"Deshpande","year":"2017","journal-title":"Am. J. Obstet. Gynecol."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"100160","DOI":"10.1016\/j.sipas.2023.100160","article-title":"The impact of minor trauma during pregnancy on maternal and neonatal outcomes: A tertiary centre experience","volume":"13","author":"Tenami","year":"2023","journal-title":"Surg. Pract. Sci."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"187","DOI":"10.1097\/00005373-197403000-00001","article-title":"The injury severity score: A method for describing patients with multiple injuries and evaluating emergency care","volume":"14","author":"Baker","year":"1974","journal-title":"J. Trauma"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"566","DOI":"10.1016\/S1072-7515(01)00818-3","article-title":"Incidental pregnancy in trauma patients","volume":"192","author":"Bochicchio","year":"2001","journal-title":"J. Am. Coll. Surg."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"1","DOI":"10.3348\/kjr.2012.13.1.1","article-title":"CT Radiation Dose Optimization and Estimation: An Update for Radiologists","volume":"13","author":"Goo","year":"2012","journal-title":"Korean J. Radiol."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"619","DOI":"10.1148\/radiol.2303021726","article-title":"Strategies for CT radiation dose optimization","volume":"230","author":"Kalra","year":"2004","journal-title":"Radiology"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"194","DOI":"10.1186\/s13244-021-01085-4","article-title":"European consensus on patient contact shielding","volume":"12","author":"Hiles","year":"2021","journal-title":"Insights Imaging"},{"key":"ref_10","unstructured":"Canadian Association of Radiologists Position Statement (2023, November 26). Discontinuing the Use of Gonadal and Fetal Shielding for Patients. Available online: https:\/\/car.ca\/wp-content\/uploads\/2021\/05\/210518-CAR-Position-Statement-Gonadal-Shielding-e.pdf."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"4","DOI":"10.1053\/j.sult.2011.09.003","article-title":"Fetal risk in diagnostic radiology","volume":"33","author":"Nguyen","year":"2012","journal-title":"Semin. Ultrasound CT MR"},{"key":"ref_12","unstructured":"American College of Radiology and the Society for Pediatric Radiology (2013, January 16). ACR-SPR Practice Guideline for Imaging Pregnant or Potentially Pregnant Adolescents and Women with Ionizing Radiation. Available online: https:\/\/www.acr.org\/-\/media\/acr\/files\/practice-parameters\/pregnant-pts.pdf."},{"key":"ref_13","doi-asserted-by":"crossref","unstructured":"American College of Obstetrics and Gynecology Committee on Obstetric Practice (2004). ACOG committee opinion: Guidelines for diagnostic imaging during pregnancy. Obstet. Gynecol., 104, 647\u2013651.","DOI":"10.1097\/00006250-200409000-00053"},{"key":"ref_14","unstructured":"American College of Radiology (2023, October 11). ACR Manual on Contrast Media. Available online: https:\/\/www.acr.org\/-\/media\/ACR\/Files\/Clinical-Resources\/Contrast_Media.pdf."},{"key":"ref_15","unstructured":"National Council on Radiation Protection and Measurements (1977). Medical Radiation Exposure of Pregnant and Potentially Pregnant Women, National Council on Radiation Protection and Measurements. Report no. 54."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"909","DOI":"10.1148\/rg.274065149","article-title":"Radiation exposure and pregnancy: When should we be concerned?","volume":"27","author":"McCollough","year":"2007","journal-title":"RadioGraphics"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"220","DOI":"10.1148\/radiol.2491071665","article-title":"Radiation dose to the fetus for pregnant patients undergoing multidetector CT imaging: Monte Carlo simulations estimating fetal dose for a range of gestational age and patient size","volume":"249","author":"Angel","year":"2008","journal-title":"Radiology"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"517","DOI":"10.1148\/radiol.2512080736","article-title":"Utilization of imaging in pregnant patients: 10-year review of 5270 examinations in 3285 patients\u20141997\u20132006","volume":"251","author":"Lazarus","year":"2009","journal-title":"Radiology"},{"key":"ref_19","first-page":"2058460119860404","article-title":"Diagnostic imaging trends in the emergency department: An extensive single-center experience","volume":"8","author":"Juliusson","year":"2019","journal-title":"Acta Radiol. Open"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"342","DOI":"10.1148\/radiol.2019191116","article-title":"Trends in Diagnostic imaging utilization among medicare and commercially insured adults from 2003 through 2016","volume":"294","author":"Hong","year":"2019","journal-title":"Radiology"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"744","DOI":"10.1148\/radiol.10100163","article-title":"Neonatal thyroid function: Effect of a single exposure to iodinated contrast medium in utero","volume":"256","author":"Bourjeily","year":"2010","journal-title":"Radiology"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"268","DOI":"10.2214\/AJR.07.3336","article-title":"Neonatal thyroid function after administration of IV iodinated contrast agent o 21 pregnant patients","volume":"191","author":"Atwell","year":"2008","journal-title":"Am. J. Roentgenol."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"165","DOI":"10.1097\/RCT.0b013e31824cc048","article-title":"Effect of in utero exposure of iodinated intravenous contrast on neonatal thyroid function","volume":"36","author":"Kochi","year":"2012","journal-title":"J. Comput. Assist. Tomogr."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"499","DOI":"10.1259\/bjr\/66819221","article-title":"Modelling the effect of lead and other materials for shielding of the fetus in CT pulmonary angiography","volume":"81","author":"Iball","year":"2008","journal-title":"Br. J. Radiol."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"353","DOI":"10.1016\/S0196-0644(96)70273-1","article-title":"Ultrasonography for the initial evaluation of blunt abdominal trauma: A review of prospective trials","volume":"27","author":"Pearl","year":"1996","journal-title":"Ann. Emerg. Med."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"581","DOI":"10.1016\/j.emc.2004.04.007","article-title":"Ultrasound in abdominal trauma","volume":"22","author":"Rose","year":"2004","journal-title":"Emerg. Med. Clin. N. Am."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"375","DOI":"10.1097\/00005373-199508000-00032","article-title":"Quantitative sensitivity of ultrasound in detecting free intraperitoneal fluid","volume":"39","author":"Branney","year":"1995","journal-title":"J. Trauma"},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"553","DOI":"10.1097\/00005373-199904000-00003","article-title":"Focused abdominal sonogram for trauma: The learning curve of non-radiologist clinicians in detecting hemoperitoneum","volume":"46","author":"Shackford","year":"1999","journal-title":"J. Trauma"},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"463","DOI":"10.1148\/radiol.2332031671","article-title":"Blunt abdominal injury in the pregnant patient: Detection with US","volume":"233","author":"Richards","year":"2004","journal-title":"Radiology"},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"689","DOI":"10.1097\/00005373-200104000-00016","article-title":"Abdominal ultrasound examination in pregnant blunt trauma patients","volume":"50","author":"Goodwin","year":"2001","journal-title":"J. Trauma"},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"851","DOI":"10.1016\/j.mri.2004.01.047","article-title":"Absence of harmful effects of magnetic resonance exposure at 1.5 T in utero during the third trimester of pregnancy: A follow-up study","volume":"22","author":"Kok","year":"2004","journal-title":"Magn. Imaging"},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"1447","DOI":"10.2214\/AJR.06.1616","article-title":"ACR guidance document for safe MR practices: 2007","volume":"188","author":"Kanal","year":"2007","journal-title":"Am J. Roentgenol."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"1061","DOI":"10.1148\/rg.2020190166","article-title":"Fetal Dosimetry at CT: A Primer","volume":"40","author":"Sensakovic","year":"2020","journal-title":"Radiographics"},{"key":"ref_34","first-page":"899","article-title":"Fetal radiation doses and subsequent risks from X-ray examinations: Should we be concerned?","volume":"11","author":"Chaparian","year":"2013","journal-title":"Iran. J. Reprod. Med."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"3","DOI":"10.1148\/rg.343135090","article-title":"Imaging of Trauma in the pregnant patient","volume":"34","author":"Raptis","year":"2014","journal-title":"Radiographies"}],"container-title":["Diagnostics"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2075-4418\/14\/3\/276\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T13:50:08Z","timestamp":1760104208000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2075-4418\/14\/3\/276"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,1,26]]},"references-count":35,"journal-issue":{"issue":"3","published-online":{"date-parts":[[2024,2]]}},"alternative-id":["diagnostics14030276"],"URL":"https:\/\/doi.org\/10.3390\/diagnostics14030276","relation":{},"ISSN":["2075-4418"],"issn-type":[{"value":"2075-4418","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,1,26]]}}}