Beneficence and non-maleficence are the basic principles underlying the application and performance of medical procedures. The use of MRI during pregnancy must conform to these principles. Given the sensitivity of the case, practitioners must apply appropriate safety measures to protect the mother and the unborn baby from any form of harm. The decision to use MRI must rely on knowledge that it is safe or has negligible potential detriments. It is important to point out that non-invasive diagnostic procedures have negative effects too. Therefore, the use of MRI during pregnancy requires absolute certainty that the effects have no lasting complications on the mother of the inborn baby. Therefore, this paper seeks to present the case for application of MRI during pregnancy by highlighting the procedure’s safety parameters.
The consensus among researchers on the safety of MRI during pregnancy is that the effects of exposure are dependent on the trimester, with the third trimester noted as the safest ( Ray et al. , 2016 ). However, doctors and nurses face difficult decisions on whether to limit the use of MRI during pregnancy to the third trimester. In a study by Ray et al. (2016) examining the relationship between exposure to MRI during pregnancy and fetal childhood outcomes, the findings suggest the presence of safety concerns during the first trimester. According to Ray et al. (2016), the heating, radiofrequency fields and loud environment associated with MRI affect sensitive tissues of the fetus and may pose health risks. Another issue contested by Ray et al. (2016) is the use of gadolinium at any trimester of pregnancy to improve accuracy. However, findings from the study on persistence of gadolinium as gadoteridol in the amniotic fluid after maternal injection during pregnancy revealed the presence of a very small amount after delivery (Prola-Netto et al. , 2017). The subjects of the study were non-human primates, but the methodological approach was similar to the one employed on pregnant women in clinical settings. The findings provide credibility to the argument about the negligibility of the effects of gadolinium following exposure during the MRI procedure.
Delegate your assignment to our experts and they will do the rest.
A substantial amount of empirical evidence exists that illustrates no harm to the expectant woman or the fetus (Nissan et al. , 2019). However, the controversial use of gadolinium continues to draw attention with some factions recommending avoidance of the compound when necessary. In a brief for the University of California, San Francisco, on MRI guidelines, Coakley et al. (2019) observed that despite Ray et al. ’s (2016) evidence on the absence of association between exposure during pregnancy and increased risk of harm to the fetus or in early childhood, the use of the procedure must adhere to the set guidelines. For instance, the American College of Gynecology and Obstetrics recommends review of pregnant patients on a case-by-case basis and decision-making on risk-benefit analysis despite no known biological effects of MRI on fetuses. The recommendation is largely applicable during the second and third trimester. However, Coakley et al. (2019) assert that the use of MRI in the first trimester is only applicable after extensive consultation with the radiology department. The implication for practice is that performance of MRI on a pregnant woman when the fetus is extremely vulnerable is acceptable when experts agree that the benefits outweigh the risks. Under such circumstances, MRI qualifies as a safe diagnostic option.
The physiological and functional applications of MRI together with its superior soft-tissue contrast have seen the proliferation of its use compared to other imaging modalities. The development is attributed to the increase in safety concerns when MRI is applied during pregnancy. Many studies examine the relationship between exposure and fetus or childhood outcomes, and identify the first trimester as the riskiest, though Ray et al. (2016) observes that evidence on the same from previous studies is non-existent. On the other hand, the use of MRI in the subsequent trimesters pose inherently less dangers. The study by Chartier et al. (2019) that explored the relationship between exposure to MRI in utero and later outcomes established no correlation. According to Chartier et al. (2019), exposure did not lead to any adverse effects on hearing or fetal growth in later life of those exposed to MRI during clinical maternal or fetal indications. The American College of Obstetricians and Gynecologists (2019) corroborates the claims raised by Ray et al. (2016) and Chartier et al. (2019) by observing that only under extenuating circumstances is MRI considered to have deleterious effects on the fetus or pregnant woman. The argument relies on evidence that most MRI procedures involve doses much lower than those associated with fetal harm. Therefore, the American College of Obstetricians and Gynecologists (2019) recommend the non-withholding of MRI from pregnant patients in need of the procedure.
In conclusion, it is important to point out that concerns regarding the safety of MRI procedure need addressing. However, the existence of divergent opinions on safety, based on contrasting findings from cohort studies complicates the issue. There is no universal consensus on the safety of MRI procedure during pregnancy. Safety concerns about exposure during the first trimester appear to be largely circumstantial because there is no empirical evidence supporting the cases. The assertions are based on knowledge of the effects of exposure to other radiological techniques. Advocacy of MRI procedure during pregnancy is based on the low dosage that is below the level known to be harmful to the fetus. On the other hand, evidence from different studies show that the use of MRI during the second and third trimesters of pregnancy has no association with any fetal harm. Nevertheless, experts warn about the use of gadolinium chelate in improving contrast, though evidence shows the compound to exist in low levels with no effects in utero or in childhood. Based on the review of evidence herein, it is apparent that MRI procedure is safe for use in pregnancy, but an expert’s opinion is crucial in cases where safety is a concern. On the other hand, extensive research is imperative to confirm or reject safety concerns, specifically those associated with exposure to MRI in the first trimester of pregnancy.
References
American College of Obstetricians and Gynecologists. (2017). Guidelines for diagnostic imaging during pregnancy and lactation: committee opinion no. 723. Obstet Gynecol , 130 , e210-6.
Chartier, A. L., Bouvier, M. J., McPherson, D. R., Stepenosky, J. E., Taysom, D. A., & Marks, R. M. (2019). The Safety of Maternal and Fetal MRI at 3T. American Journal of Roentgenology , 1-4.
Coakley, F., Robert, G., Hess, C., Hope, M., Russell, K., & Mari-Paule, T. (2019). Guidelines for the Use of CT and MRI During Pregnancy and Lactation. University of California, San Francisco. Retrieved from https://radiology.ucsf.edu/patient-care/patient-safety/ct-mri-pregnancy#accordion-summary-and-key-points-for-oncall-residents
Nissan, N., Furman‐Haran, E., Allweis, T., Menes, T., Golan, O., Kent, V., ... & Bordsky, A. (2019). Noncontrast breast MRI during pregnancy using diffusion tensor imaging: A feasibility study. Journal of Magnetic Resonance Imaging , 49 (2), 508-517.
Prola-Netto, J., Woods, M., Roberts, V. H., Sullivan, E. L., Miller, C. A., Frias, A. E., & Oh, K. Y. (2017). Gadolinium chelate safety in pregnancy: barely detectable gadolinium levels in the juvenile nonhuman primate after in utero exposure. Radiology , 286 (1), 122-128.
Ray, J. G., Vermeulen, M. J., Bharatha, A., Montanera, W. J., & Park, A. L. (2016). Association between MRI exposure during pregnancy and fetal and childhood outcomes. Jama , 316 (9), 952-961.
