A Matter of Ethics
I often feel a sense of uneasiness when I have to scan a pregnant woman. I wonder if the risks were explained in language she could clearly understand and if alternative testing options were discussed. Did she sign the consent form because she was scared and being pressured or because she truly felt it was the best decision for her and her baby? Was she made aware of the radiation risks to her fetus and her own breast tissue? Does she know the iodinated based contrast is harmful to her baby?
I have scanned two pregnant women in the past few weeks. The first one was in her first trimester and when I asked her if the doctor explained the risks to her she said yes and was told that there was very little risk. She wasn't told that the during first trimester is when the most damage can be done. She gladly went along with her scan of a CTA chest to rule out pulmonary embolism (PE) as her chief complaint was chest pain. Her test came back negative.
It was a slightly different story with the next pregnant woman I scanned. Just as I was about to get her on the CT table she said she was scared, began to tear up, and refused the exam. She was in her third trimester. I gladly took her back to her room and informed her doctor that she didn't want the exam because she was concerned about the risks. He appeared visibly upset about this and said he would talk to her. She had asked him about other safer testing options and he stated, "This is the safest test." I was left to ponder the safest test for who? She had the same test of a CTA chest to rule out PE and her results came back negative.
Research shows that pulmonary embolism (PE) is the leading cause of maternal mortality in the developed world. so it is only fitting that when a pregnant woman presents to an ER with chest pain this be taken seriously. CT scans usually offer the best diagnosis for PE but some research advocates for the use of MRI or VQ scans. All research shows that the contrast used in any of the studies is harmful to the fetus.
Where does all of this information leave me as the person who performs the exam? What do I say when a scared woman looks up at me and asks me if this test is safe for me and my baby?