This Article Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Brown, M. A. Articles by Casola, G. Search for Related Content PubMed PubMed Citation Articles by Brown, M. A. Articles by Casola, G.

Screening Sonography in Pregnant Patients With Blunt Abdominal Trauma

Departments of Radiology (M.A.B., C.B.S., N.F., G.C.) and Surgery (D.B.H.), University of California San Diego Medical Center, San Diego, California USA.

Address correspondence and reprint requests to Michèle A. Brown, MD, Department of Radiology, University of California San Diego Medical Center, 200 W Arbor Dr, San Diego, CA 92103-8756 USA. E-mail: m9brown{at}ucsd.edu

Objective. The purpose of this study was to evaluate the accuracy of screening sonography for the detection of clinically significant abdominal injury in pregnant patients with blunt trauma. Methods. We retrospectively reviewed the records of 5173 patients with blunt abdominal trauma who underwent screening sonography. Pregnant patients were identified, and the prospective sonographic interpretations were compared with surgical findings, computed tomography (CT), subsequent sonography, cystography, and the clinical course. Results. Of 1567 female patients with trauma, 947 were of reproductive age and, 102 (11%) of these 947 were pregnant. One patient was excluded because a truth standard was not available. Five (5%) of these 101 patients were found to have injuries at surgery. These injuries involved the placenta (2 injuries), spleen (2 injuries), liver (1 injury), and kidney (1 injury); all required surgery. Initial sonographic findings were positive in 4 of 5 patients with injuries. The missed injury was a placental injury detected 15 hours after screening sonography because of fetal bradycardia. After screening sonography, 6 patients underwent additional abdominal imaging: CT (3 patients), cystography (1 patient), and additional sonography (2 patients). Of 101 patients, 95 (94%) required no additional tests, and 97 (96%) required no test involving ionizing radiation. No pregnant patient underwent diagnostic peritoneal lavage. Sensitivity was 80% (95% confidence interval, 28%–100%), and specificity was 100% (96 of 96; 95% confidence interval, 96%–100%) for detecting major abdominal injury. Conclusions. Sonography is an effective screening examination that can obviate more hazardous tests such as CT, cystography, and peritoneal lavage in most pregnant patients with trauma requiring objective evaluation of the abdomen.

Key Words: abdomen • pregnancy • sonography • trauma

Abbreviations: CT, computed tomography • DPL, diagnostic peritoneal lavage

This article has been cited by other articles:

				M. Korner, M. M. Krotz, C. Degenhart, K.-J. Pfeifer, M. F. Reiser, and U. Linsenmaier Current Role of Emergency US in Patients with Major Trauma RadioGraphics, January 1, 2008; 28(1): 225 - 242. [Abstract] [Full Text] [PDF]

				S. J. Patel, D. L. Reede, D. S. Katz, R. Subramaniam, and J. K. Amorosa Imaging the Pregnant Patient for Nonobstetric Conditions: Algorithms and Radiation Dose Considerations RadioGraphics, November 1, 2007; 27(6): 1705 - 1722. [Abstract] [Full Text] [PDF]

				T. G. ODLE Blunt Pelvic Trauma Radiol. Technol., January 1, 2006; 77(3): 200 - 219. [Abstract] [Full Text] [PDF]