BackTable / VI / Podcast / Episode #288
Treating the Pregnant Patient
with Dr. Nikki Keefe
In this episode, our host Dr. Ally Baheti interviews interventional radiologist Dr. Nikki Keefe about safety considerations for pregnant and breastfeeding IR patients.
BackTable, LLC (Producer). (2023, February 3). Ep. 288 – Treating the Pregnant Patient [Audio podcast]. Retrieved from https://www.backtable.com
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Dr. Nikki Keefe
Dr. Nikki Keefe is a vascular and interventional radiologist, assistant professor, and associate program director at UNC in Chapel Hill, North Carolina.
Dr. Aparna Baheti
Dr. Aparna Baheti is a practicing Interventional Radiologist in Tacoma, Washington.
Dr. Keefe’s personal experience with pregnancy during her IR training sparked her interest in this topic. A lot of IR patients are pregnant or breastfeeding, so it is important to be cognizant of radiation and medication exposures and how they should be altered. She emphasizes the importance of establishing a protocol when these patients present.
We review radiation doses of various IR procedures and risk stratification based on gestational age. At each stage of pregnancy, there are different risks of disruptions in organogenesis, effects on neural tube development, and predisposition to cancer. Elective procedures should usually be deferred until after delivery. The most common and necessary procedures performed in pregnant patients are PICC line placement, nephrostomy tube, and treatment of postpartum hemorrhage. Dr. Keefe also shares her tips for minimizing fluoroscopy time and deciding between different diagnostic imaging modalities that present both maternal and fetal radiation risks.
Next, we discuss medication safety. Iodinated contrast is safe to give during pregnancy, while gadolinium is not. Sedation with opioids is generally safe, but their sustained use or administration around the perinatal period can cause neonatal withdrawal symptoms. Benzodiazepines can also be used for amnesia and anxiety reduction, and midazolam has a good safety profile and long half life. However, abnormally extended use of benzodiazepines can cause floppy infant syndrome (sedation, muscle laxity, failure to suckle). Dr. Keefe notes that pregnant patients have to start on higher doses than the standard, since they have higher blood volume and increased renal clearance of these medications. Lovenox is the safest known anticoagulant for pregnant women. Additionally, fetal heart monitoring should be performed before and after the procedure.
Finally, we talk about specific cases of patient positioning when placing nephrostomy tubes, transhepatic access for gallbladder tubes, treatment of visceral artery aneurysms before pregnancy, and selection of imaging modalities to detect pulmonary embolism.
Society for Vascular Surgery (SVS) clinical practice guidelines on the management of visceral aneurysms:
Risk Factors for and Clinical Management of Venous Thromboembolism During Pregnancy:
Disclaimer: The Materials available on BackTable.com are for informational and educational purposes only and are not a substitute for the professional judgment of a healthcare professional in diagnosing and treating patients. The opinions expressed by participants of the BackTable Podcast belong solely to the participants, and do not necessarily reflect the views of BackTable.