The use of different imaging modalities in acute abdominal pain in pregnancy

Research output: Contribution to conferencePosterpeer-review


Background and Purpose: Abdominal pain during pregnancy is quite common with a wide differential diagnosis including both obstetric and non-obstetric pathologies. Diagnostic imaging modalities used in addition to history and physical examination (PE) are often ultrasound (US) and magnetic resonance imaging (MRI). We sought to find the role of these tests in pregnant patients who presented to our emergency department with acute abdominal pain. Previous studies examined the efficacy of MRI as a first diagnostic imaging modality in the setting of acute abdominal pain in pregnancy concerning for acute appendicitis without conclusive objective findings.

The objective of this study is to determine the ability of ultrasound and physical exam findings in correctly identifying renal or hepatobiliary pathology in pregnant patients presenting with acute abdominal pain compared to the use of MRI.

Materials And Methods: This is a retrospective analysis of 136 pregnant women with acute abdominal pain who presented to the emergency department (ED) at Ascension Genesys Hospital, Grand Blanc, MI. PE, US, MRI, gestational age, comorbid conditions, and length of stay were reviewed. Statistical analysis was done using T-test and chi-square test. Institutional review board approval was obtained.

Results: Our study found that the mean age was 26.8 (±5.4) years and the mean gestational age was 16.5 (±8.4) weeks. Of those patients, there were 59 patients who had an US and 47 with subsequent MRI performed. The US demonstrated abnormal findings in 8 patients for renal or hepatobiliary pathology; 2 patients demonstrating cholelithasis, 1 demonstrating choledocholithasis, 1 with “prominent biliary sludge and small stones,” and 4 with mild to moderate hydronephrosis. The MRI demonstrated abnormal findings in 11 patients; 7 with mild to moderate hydronephrosis, with 1 commenting on “mild perinephric fluid, with the middle 1/3 R ureter compressed between the enlarged gravid uterus and psoas muscle”, 1 with choledochal cyst, 1 with cholelithasis, 1 with cholelithasis and stricture of common bile duct, and 2 with hepatic lesions. Of those patients, 3 underwent a procedure for their acute pain including biliary stent placement, ERCP, and cystoscopy with ureteral stent placement. Of those 3 patients who underwent surgical procedure, all had abnormal US confirmed with abnormal MRI.

Conclusion: Previous studies have demonstrated that in the setting of acute abdominal pain in pregnancy and positive PE highly suggestive of surgical pathology, especially in the setting of RLQ pain and suspicion for appendicitis, US had limited value and patients should proceed to MRI. This data suggests that US is an appropriate step in work up with gravid patients with acute abdominal pain. Ultrasound is a cost effective and reliable screening tool for renal or hepatobiliary pathology that is safe during pregnancy. The determination for if an MRI is necessary should be based on clinical suspicion and provider preference. Ultimately the decision for surgical intervention should be determined by clinical suspicion. Further studies would benefit from a higher power.
Original languageAmerican English
StatePublished - 16 Feb 2024
Oklahoma State University Center for Health Sciences Research Week 2024
- Oklahoma State University Center for Health Sciences, Tulsa, United States
Duration: 13 Feb 202417 Feb 2024


Oklahoma State University Center for Health Sciences Research Week 2024
Country/TerritoryUnited States
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