PERIOPERATIVE RADIATION EXPOSURE IN A PREGNANT WOMAN

*Corresponding author: Professor Pradeep K Singh, Department of Orthopaedics, Jawahar Lal Nehru Medical College, DMIMS, Wardha, Maharashtra, India. Fax: +91 7152 287714 E-mail: drpradeepsingh@gmail.com The perioperative imaging of a pregnant woman presents a unique challenge to orthopaedics surgeon as concern about the radiation risk to the embryo or fetus. This article highlights effect of radiation exposure on foetus. I would like to discuss about the amount of radiation exposure in a pregnant woman during fluoroscopic guided closed femoral Interlock nailing as radiation has significant cancerous and non cancerous effect on fetus. Trauma is one the leading nonobstetric cause of maternal death in as many as 8% of pregnancies (1). The principal causes of trauma in pregnancy include motor vehicle accidents. Domestic falls, domestic violence, and penetrating wounds are involved in 10% of trauma during pregnancy (1). Diagnosis and treatment of fracture of the long bone of the lower limb in pregnant patients has it own peculiar risk of exposing foetus to ionizing radiations during X-ray evaluation and image intensifier guided treatment, which may lead to abnormal embryogenesis and congenital anomaly (2). A 30 year old with presented at 24 week gestation of pregnancy who got injured when a broken wall accidently fell over her right lower limb. She was brought to the Acharya Vinoba Bhave Rural Hospital accident and emergency department with signs of hypovolumic shock. She was resuscitated with volume and blood transfusion and fetal wellbeing was assured with ultrasonography thereafter. On examination of abdomen uterine fundus was palpable just above the level of the umbilicus. Ultrasonography confirmed a gravid uterus of 24 weeks gestational age, with fetal heart rate of 130 per minute. She did not suffer any other injury. X-ray was taken after shielding the abdomen, revealed a displaced comminuted fracture of the right femur (figure 1). Patient and her relatives were counseled about the management and its outcome stressing upon the radiation exposure and its subsequent sequeal. Closed reduction and Intramedullary Interlocking nail was done with the help of guarded fluoroscopy. Distal interlocking was done without using image intensifier. Post operative radiograph showed good reduction, implant position and locking bolts (figure 2). We protected the patient and foetus from radiation exposure by draping the lead sheet over her abdomen from all around. Excess radiation exposure was prevented by using minimum number of shots of image intensifier. She was discharged from the ward after an appointment with the Obstetrician. Obstetrician planned for elective caesarean section at completion of 39 weeks of gestation. Baby and mother were normal at the time of discharge from the obstetrics ward. Patient regained her previous functional status. Maximal permissible ionizing radiation from X rays for upper or lower extremity is 100 mGy units (2). Exposure beyond 100 mGy (1 mGy =100 mrad) may cause cancerous effects on fetus during first trimester of pregnancy (3, 4). Non cancerous effects on the embryo or fetus Iran. J. Radiat. Res., 2011; 8 (4): 253-255 Archive of SID