Acute Abdominal Pain in Pregnant Patients: Evidence-Based Emergency Imaging

  • Ania Z. KielarEmail author
  • Suzanne T. Chong
Part of the Evidence-Based Imaging book series (Evidence-Based Imag.)


Challenges often arise when choosing imaging for pregnant women with acute abdominal and pelvis symptoms. Efficient, accurate, and safe ways to make a diagnosis are key in this patient population; cross-sectional imaging with ultrasound and magnetic resonance imaging play key roles, along with judicious use of computed tomography, when warranted. A review of current evidence, including levels of available published evidence, will be reviewed in detail for commonly encountered conditions occurring during pregnancy. This will include both obstetric and gynecologic abnormalities and other, often unrelated, abdominal and pelvis pathologies.


Pregnancy Emergent conditions Bowel obstruction Torsion Ectopic pregnancy Image wisely Evidence-based imaging Emergency imaging 

List of Abbreviations


American Congress of Obstetricians and Gynecologists


American College of Radiology


As low as reasonably achievable


Computed tomography


Left lower quadrant


Left upper quadrant


Magnetic resonance imaging


Negative predictive value


Obstetrics and gynecology


Positive predictive value


Right lower quadrant


Right upper quadrant


Specific absorption rate


Society of Obstetricians and Gynecologists




  1. 1.
    Augustin G, Majerovic M. Eur J Obstet Gynecol Reprod Biol. 2007;131(1):4–12.CrossRefPubMedGoogle Scholar
  2. 2.
    Kastenberg ZJ, Hurley MP, Luan A, et al. Obstet Gynecol. 2013;122(4):821–9.CrossRefPubMedCentralPubMedGoogle Scholar
  3. 3.
    Brent RL. Semin Oncol. 1989;16:347–68.PubMedGoogle Scholar
  4. 4.
    Rosen MP, Ding A, Blake MA, et al. J Am Coll Radiol. 2011;8(11):749–55.CrossRefPubMedGoogle Scholar
  5. 5.
    Patenaude Y, Pugash D, Lim K, et al. J Obstet Gynaecol Can. 2014;36(4):349–63.CrossRefPubMedGoogle Scholar
  6. 6.
    Smith MP, Katz DS, Lalani T, et al. Ultrasound Q. 2015;31(2):85–91.CrossRefPubMedGoogle Scholar
  7. 7.
    Mahmoodian S. South Med J. 1992;85:19–24.CrossRefPubMedGoogle Scholar
  8. 8.
    Leyendecker JR, Gorengaut V, Brown JJ. Radiographics. 2004;24(5):1301–16.CrossRefPubMedGoogle Scholar
  9. 9.
    Wagner LK, Applegate K, American College of Radiology. ACR practice guideline for imaging pregnant or potentially pregnant adolescents and women with ionizing radiation. In: Practice guidelines & technical standards 2008 (resolution 26).Google Scholar
  10. 10.
    ACOG Committee Opinion No. 299. Obstet Gynecol. 2004;104(3):647–51.CrossRefGoogle Scholar
  11. 11.
    Aggenbach L, Zeeman CG, Cantineau AE, et al. Int J Surg. 2015;15C:84–9.CrossRefGoogle Scholar
  12. 12.
    Lemieux P, Rheaume P, Levesque I, et al. Surg Endosc. 2009;23(8):1701–5.CrossRefPubMedGoogle Scholar
  13. 13.
    Orr RK, Porter D, Hartman D. Acad Emerg Med. 1995;2(7):644–50.CrossRefPubMedGoogle Scholar
  14. 14.
    Lim HK, Bae SH, Seo GS. Am J Roentgenol. 1992;159(3):539–42.CrossRefGoogle Scholar
  15. 15.
    Poortman P, Lohle PN, Schoemaker CM, et al. Am J Roentgenol. 2003;181(5):1355–9.CrossRefGoogle Scholar
  16. 16.
    Pedrosa I, Levine D, Eyvazzadeh AD, et al. Radiology. 2006;238(3):891–9.CrossRefPubMedGoogle Scholar
  17. 17.
    Blumenfeld YJ, Wong AE, Jafari A, et al. J Matern Fetal Neonatal Med. 2011;24(3):485–8.CrossRefPubMedGoogle Scholar
  18. 18.
    Singla LS, Long C, Lai H, et al. Am J Roentgenol. 2011;196:4–12.CrossRefGoogle Scholar
  19. 19.
    Shetty MK, Garrett NM, Carpenter WS, et al. Semin Ultrasound CT MR. 2010;31:8–13.CrossRefPubMedGoogle Scholar
  20. 20.
    Baron KT, Arleo EK, Robinson C, et al. Emerg Radiol. 2012;19(6):519–25.CrossRefPubMedGoogle Scholar
  21. 21.
    Basaran A, Basaran M. Obstet Gynecol Surv. 2009;64:481–8.CrossRefPubMedGoogle Scholar
  22. 22.
    Lazarus E, Mayo-Smith WW, Mainiero MB, et al. Radiology. 2007;204:784–90.CrossRefGoogle Scholar
  23. 23.
    Ko CW, Beresford SA, Schulte SJ, et al. Hepatology. 2005;41(2):359–65.CrossRefPubMedGoogle Scholar
  24. 24.
    Khandelwal A, Fasih F, Kielar A. Radiol Clin North Am. 2013;51(6):1005–22.CrossRefPubMedGoogle Scholar
  25. 25.
    Wang PI, Chong ST, Kielar AZ, et al. Am J Roentgenol. 2012;198:785–92.CrossRefGoogle Scholar
  26. 26.
    Yarmish GM, Smith MP, Rosen MP, et al. J Am Coll Radiol. 2014;11(3):316–22.CrossRefPubMedCentralPubMedGoogle Scholar
  27. 27.
    Ralls PW, Colletti PM, Lapin SA, et al. Radiology. 1985;155(3):767–71.CrossRefPubMedGoogle Scholar
  28. 28.
    Oto A, Ernst R, Ghulmiyyah L, et al. Br J Radiol. 2009;82:279–85.CrossRefPubMedGoogle Scholar
  29. 29.
    Kiewiet JJ, Leeuwenburgh MM, Bipat S, et al. Radiology. 2012;264(3):708–20.CrossRefPubMedGoogle Scholar
  30. 30.
    Kilpatrick CC, Monga M. Obstet Gynecol Clin North Am. 2007;34(3):389–402.CrossRefPubMedGoogle Scholar
  31. 31.
    Parangi S, Levine D, Henry A, et al. Am J Surg. 2007;193:223–32.CrossRefPubMedGoogle Scholar
  32. 32.
    Ros PR, Huprich JE. J Am Coll Radiol. 2006;3(11):838–41.CrossRefPubMedGoogle Scholar
  33. 33.
    Torres-Villalobos GM, Kellogg TA, Leslie DB, et al. Obes Surg. 2009;19(7):944–50.CrossRefPubMedGoogle Scholar
  34. 34.
    Rosenkrantz AB, Kurian M, Kim D. Clin Radiol. 2010;65(3):246–9.CrossRefPubMedGoogle Scholar
  35. 35.
    McKenna DA, Meehan CP, Alhajeri AN, et al. Br J Radiol. 2007;80(949):e11–4.CrossRefPubMedGoogle Scholar
  36. 36.
    Hand JW, Li Y, Thomas EL, Rutherford MA, et al. Magn Reson Med. 2006;55(4):883–93.CrossRefPubMedGoogle Scholar
  37. 37.
    Chen MM, Coakley FV, Kaimal A, et al. Obstet Gynecol. 2008;112:333–40.CrossRefPubMedGoogle Scholar
  38. 38.
    Bourjeily G, Chalhoub M, Phornphutkul C, et al. Radiology. 2010;256:744–750.6.CrossRefPubMedGoogle Scholar
  39. 39.
    Atwell TD, Lteif AN, Brown DL, et al. Am J Roentgenol. 2008;191:268–71.CrossRefGoogle Scholar
  40. 40.
    Butler EL, Cox SM, Eberts EG, et al. Obstet Gynecol. 2000;96:753–6.PubMedGoogle Scholar
  41. 41.
    Parulkar BG, Hopkins TB, Wollin MR, et al. J Urol. 1998;159:365–8.CrossRefPubMedGoogle Scholar
  42. 42.
    Masselli G, Derme M, Laghi F, et al. Abdom Imaging. 2013;38:1409–14.CrossRefPubMedGoogle Scholar
  43. 43.
    Fiadjoe P, Kannan K, Rane A. Eur J Obstet Gynecol Reprod Biol. 2010;152(1):13–7.CrossRefPubMedGoogle Scholar
  44. 44.
    Shokeir AA, Abdulmaaboud M. BJU Int. 1999;83:378–82.CrossRefPubMedGoogle Scholar
  45. 45.
    Ripollés T, Agramunt M, Errando J, et al. Eur Radiol. 2004;14(1):129–36.CrossRefPubMedGoogle Scholar
  46. 46.
    Silverman SG, Leyendecker JR, Amis ES. Radiology. 2009;250(2):309–23.CrossRefPubMedGoogle Scholar
  47. 47.
    Nikken JJ, Krestin GP. Eur Radiol. 2007;17:2780–93.CrossRefPubMedCentralPubMedGoogle Scholar
  48. 48.
    Sadro C, Bernstein MP, Kanal KM. Am J Roentgenol. 2012;199(6):1207–19.CrossRefGoogle Scholar
  49. 49.
    Mirza FG, Devine PC, Gaddipati S. Am J Perinatol. 2010;27:579–86.CrossRefPubMedGoogle Scholar
  50. 50.
    Wang PI, Chong ST, Kielar AZ, et al. Am J Roentgenol. 2012;198(4):778–84.CrossRefGoogle Scholar
  51. 51.
    Jain V, Chari R, Maslovitz S, et al. J Obstet Gynaecol Can. 2015;37(6):553–74.CrossRefPubMedGoogle Scholar
  52. 52.
    Brown MA, Sirlin CB, Farahmand N, et al. J Ultrasound Med. 2005;24(2):175–81.CrossRefPubMedGoogle Scholar
  53. 53.
    Newman J. Can Fam Physician. 2007;53(4):630–1.PubMedCentralPubMedGoogle Scholar
  54. 54. website. Ectopic Pregnancy.
  55. 55.
    Androett FR, Lee SI, DeJesus SO, et al. Ultrasound Q. 2011;27(3):205–10.CrossRefGoogle Scholar
  56. 56.
    Parvey HR, Dubinsky TJ, Johnston DA, et al. Am J Roentgenol. 1996;167(6):1479–85.CrossRefGoogle Scholar
  57. 57.
    Govindarajan MJ, Rajan R. J Hum Reprod Sci. 2008;1(1):37–8.CrossRefGoogle Scholar
  58. 58.
    Wei SH, Helmy M, Cohen AJ. Emerg Radiol. 2009;16:365–73.CrossRefPubMedCentralPubMedGoogle Scholar
  59. 59.
    Shah KH, Simons RK, Holbrook T, et al. J Trauma. 1998;45:83–6.CrossRefPubMedGoogle Scholar
  60. 60.
    Pearlman MD, Klinich KD, Schneider LW, et al. Am J Obstet Gynecol. 2000;182:1554–64.CrossRefPubMedGoogle Scholar
  61. 61.
    Oyelese Y, Ananth CV. Obstet Gynecol. 2006;108(4):1005–16.CrossRefPubMedGoogle Scholar
  62. 62.
    Grossman NB. Am Fam Physician. 2004;70:1303–18.PubMedGoogle Scholar
  63. 63.
    Feldstein VA, Harris RD, Machin GA. Ultrasound of the placenta and umbilical cord. In: Callen PW, editor. Ultrasonography in obstetrics and gynecology. 4th ed. Philadelphia, PA: Saunders; 2000. p. 597–625.Google Scholar
  64. 64.
    Manriquez M, Srinivas G, Bollepalli S, et al. Am J Obstet Gynecol. 2010;202:611.CrossRefPubMedGoogle Scholar
  65. 65.
    Wallace GW, David MA, Semelka RC, et al. Abdominal Imaging. 2012;37:849–60.CrossRefPubMedGoogle Scholar
  66. 66.
    Shadinger LL, Andreotti RF, Kurian RL. J Ultrasound Med. 2008;27(1):7–13.CrossRefPubMedGoogle Scholar
  67. 67.
    Molander P, Sjoberg J, Paavonen J, et al. Ultrasound Obstet Gynecol. 2001;17(3):233–8.CrossRefPubMedGoogle Scholar
  68. 68.
    Spalluto LB, Woodfield CA, DeBenedectis CM, et al. Radiographics. 2012;32(2):317–34.CrossRefPubMedGoogle Scholar

Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Department of ImagingThe Ottawa HospitalOttawaCanada
  2. 2.Department of RadiologyMichigan MedicineAnn ArborUSA

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