{"id":10622,"date":"2020-07-07T13:29:59","date_gmt":"2020-07-07T13:29:59","guid":{"rendered":"https:\/\/jurmed.ro\/medici\/?p=10622"},"modified":"2020-07-07T13:30:48","modified_gmt":"2020-07-07T13:30:48","slug":"impactul-explorarilor-radiologice-in-timpul-sarcinii","status":"publish","type":"post","link":"https:\/\/jurmed.ro\/medici\/impactul-explorarilor-radiologice-in-timpul-sarcinii\/","title":{"rendered":"Impactul explor\u0103rilor radiologice \u00een timpul sarcinii"},"content":{"rendered":"
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Autor: Dr. Mircea Onofriescu Profesor universitar doctor \u00een medicin\u0103 Specialist \u00een obstetric\u0103 \u0219i ginecologie<\/figcaption><\/figure>\n

Rezumat<\/u><\/strong><\/p>\n

\u00cen timpul sarcinii pot apare diverse afec\u0163iuni materne care necesit\u0103 uneori examene radiologice pentru stabilirea diagnosticului \u0219i conduitei terapeutice. \u00cen aceste situa\u0163ii, at\u00e2t medicul c\u00e2t \u0219i gravida, \u00ee\u0219i pun problema riscului pe care \u00eel prezint\u0103 aceste explor\u0103ri asupra dezvolt\u0103rii fetale. \u00cen realitate acest risc este redus \u0219i include o u\u0219oar\u0103 cre\u0219tere a inciden\u0163ei leucemiei infantile \u0219i probabil a ratei muta\u0163iilor genetice. Numeroase malforma\u0163ii fetale apar f\u0103r\u0103 o cauz\u0103 identificabil\u0103. Perioada 10-17 s\u0103pt\u0103m\u00e2ni de gesta\u0163ie reprezint\u0103 perioada de sensibilitate maxim\u0103 a sistemului nervos central la ac\u0163iunea factorilor teratogeni, astfel \u00eenc\u00e2t explor\u0103rile radiologice f\u0103r\u0103 caracter de urgen\u0163\u0103 trebuie evitate \u00een aceast\u0103 perioad\u0103. \u00cen situa\u0163ia \u00een care diagnosticul imagistic este absolut necesar echografia reprezint\u0103 o alternativ\u0103 de mare valoare. Pentru evitarea problemelor \u0219i lini\u0219tirea pacientelor este esen\u0163ial\u0103 informarea corect\u0103 a acestora \u00eenaintea efectu\u0103rii unei explor\u0103ri radiologice, mai ales \u00een situa\u0163iile \u00een care pacienta a fost investigat\u0103 f\u0103r\u0103 a se exclude posibilitatea existen\u0163ei unei sarcini \u00een evolu\u0163ie. \u00cen concluzie, este extrem de important cunoa\u0219terea acestor date de c\u0103tre medicii de famile precum \u0219i de c\u0103tre medicii de alte specialit\u0103\u0163i dec\u00e2t obstetric\u0103 \u0219i ginecologie.<\/p>\n

\u00cen Uniunea European\u0103 au fost stabilite deja m\u0103suri de radioprotec\u0163ie \u0219i au fost stabilite din 1984 condi\u0163iile de utilizare \u00een scop diagnostic \u0219i terapeutic a radia\u0163iilor ionizante (Directiva 84\/466\/Euratom). Cre\u0219terea utiliz\u0103rii radia\u0163iilor ionizante, multiplicarea serviciilor medicale dotate \u00een acest sens, diversificarea \u0219i perfec\u0163ionarea procedurilor de diagnostic \u0219i tratament au impus modificarea regulilor de utilizare a radia\u0163iilor ionozante. Directiva 97\/43\/Euratom a fost adoptat\u0103 de Consiliul Uniunii Europene la 30 iunie 1997. Recomand\u0103rile sunt adresate medicilor de familie, medicilor speciali\u0219ti care recomand\u0103 examene radiologice sau tratamente ce impun expunere la radia\u0163ii ionizante, asistentelor medicale \u0219i \u00een special asistentelor \u0219i medicilor care lucreaz\u0103 \u00een servicii de obstetric\u0103 \u0219i ginecologie.<\/p>\n

\u00cen timpul sarcinii pot apare diverse afec\u0163iuni materne care necesit\u0103 examene radiologice pentru stabilirea diagnosticului \u0219i conduitei terapeutice \u0219i uneori expunerea radiologic\u0103 poate avea loc \u00een primul trimestru de sarcin\u0103 la paciente la care medicul nu face o anamnez\u0103 corect\u0103 sau pacienta prezint\u0103 menometroragii care mascheaz\u0103 sarcina. Am considerat necesar\u0103 prezentarea celor mai recente date privind efectele poten\u0163iale ale radia\u0163iilor asupra f\u0103tului.<\/p>\n

\u00cen cadrul popula\u0163iei generale exist\u0103 tendin\u0163a supraestim\u0103rii riscurilor asupra dezvolt\u0103rii fetale datorate explor\u0103rilor radiologice \u0219i din p\u0103cate, aceast\u0103 tendin\u0163\u0103 se manifest\u0103 \u0219i \u00een r\u00e2ndul medicilor, conduc\u00e2nd la sc\u0103derea calit\u0103\u0163ii asisten\u0163ei medicale. Un alt aspect ar fi efectuarea examenelor radiologice la femei la care nu s-a exclus diagnosticul de sarcin\u0103.<\/p>\n

Faptul c\u0103 \u00eentr-o scurt\u0103 perioad\u0103 de timp m-am confruntat cu mai multe cazuri de explor\u0103ri radiologice efectuate \u00een primul trimestru de sarcin\u0103 m-a determinat s\u0103 consult literatura de specialitate \u0219i consider util\u0103 prezentarea celor mai recente date din literatura.<\/p>\n

Prezentare de cazuri<\/u><\/strong><\/p>\n

Pacienta P.A de 35 ani din jude\u0163ul Suceava, a efectuat o histerosalpingografie pe data de 31 mai 2002, \u00eentr-o clinic\u0103 universitar\u0103. Ultima menstrua\u021bie a fost considerat\u0103 pe 25 mai 2002. Ulterior s-a constatat sarcin\u0103 intrauterin\u0103. Examenele ecografice endovaginale \u0219i ulterior abdominale au confirmat c\u0103 ultima menstrua\u0163ie data de 26 aprilie 2002. Explorarea radiologic\u0103 a fost efectuat\u0103 la 5 s\u0103pt\u0103m\u00e2ni de amenoree \u0219i la 3 s\u0103pt\u0103m\u00e2ni de la data probabil\u0103 a fecunda\u0163iei. Monitorizat\u0103 prin triplu test \u0219i ecografie morfologic\u0103 fetal\u0103, evolu\u0163ie favorabil\u0103. Na\u0219te prin cezarian\u0103 pe data de 26 ianuarie 2003, un f\u0103t viu, sex feminin, greutate de 3100g, Apgar 9. Evolu\u0163ie normal\u0103 a dezvolt\u0103rii neo\u00adnatale.<\/p>\n

Pacienta D. M. de 28 ani din Ia\u0219i efectueaz\u0103 o radioscopie pulmonar\u0103 recomandat\u0103 de medicul de familie \u00een condi\u0163iile unei amenorei de 10 zile. Ulterior se confirm\u0103 clinic, ecografic \u0219i hormonal sarcin\u0103 intrauterin\u0103 de 6 s\u0103pt\u0103m\u00e2ni. La recomandarea unui obstetrician \u0219i insisten\u021bele prietenilor se practic\u0103 chiuretaj uterin, pe care \u00eel consider\u0103m ca un gest medical exagerat.<\/p>\n

Pacienta U.E. de 45 de ani din Ia\u0219i, rec\u0103s\u0103torit\u0103, so\u0163ul de 45 ani f\u0103r\u0103 copii, efectueaz\u0103 un examen radiologic gastric baritat \u00een condi\u0163iile existen\u0163ei unei sarcini de 3 s\u0103pt\u0103m\u00e2ni. Consultarea articolelor de pe internet determin\u0103 cuplul s\u0103 men\u0163in\u0103 sarcina. Sarcina a fost monitorizat\u0103 inclusiv prin amniocentez\u0103. Na\u0219te prin cezarian\u0103 la 37 SA, un f\u0103t viu, s\u0103n\u0103tos de 2800g, Apgar 9.<\/p>\n

No<\/u><\/strong>\u0163<\/u><\/strong>iuni de baz<\/u><\/strong>\u0103<\/u><\/strong> despre radia<\/u><\/strong>\u0163<\/u><\/strong>ii<\/u><\/strong><\/p>\n

Radia\u0163iile ionizante (razele X) sunt formate din fotoni de mare energie care sunt capabili s\u0103 modifice structura ADN-ului \u0219i s\u0103 genereze radicali liberi toxici. [1]<\/sup><\/strong> Unit\u0103\u0163ile de m\u0103sur\u0103 folosite pentru a exprima dozele de radia\u0163ii administrate unui pacient sunt:\u00a0Gray (Gy), Rem<\/em><\/strong>\u00a0sau o unitate mai veche \u0219i mai des folosit\u0103 –\u00a0Rad<\/em><\/strong>. Dozele estimative ale expunerii fetale \u00een cursul diverselor explor\u0103ri imagistice sunt prezentate \u00een tabelul 1. [2]<\/sup><\/strong><\/p>\n

TABEL 1 – doze estimative ale expunerii fetale \u00een cursul diferitelor explor\u0103ri imagistice<\/strong><\/p>\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n
<\/td>\nTipul explor\u0103rii<\/strong><\/td>\nDoza estimat\u0103 (Rad )*<\/strong><\/td>\nNum\u0103r de explor\u0103ri necesare pentru atingerea dozei cumulative maxime de 5\u00a0Rad<\/strong><\/td>\n<\/tr>\n
Radiografie<\/strong><\/td>\n<\/td>\n<\/td>\n<\/td>\n<\/tr>\n
\u00a0<\/strong><\/td>\nCraniu<\/td>\n0.004<\/td>\n1250<\/td>\n<\/tr>\n
\u00a0<\/strong><\/td>\nDantur\u0103<\/td>\n0.0001<\/td>\n50000<\/td>\n<\/tr>\n
\u00a0<\/strong><\/td>\nM\u00e2n\u0103, picior<\/td>\n0.001<\/td>\n5000<\/td>\n<\/tr>\n
\u00a0<\/strong><\/td>\nTorace (2 incidente)<\/td>\n0.00007<\/td>\n71429<\/td>\n<\/tr>\n
\u00a0<\/strong><\/td>\nMamografie<\/td>\n0.02<\/td>\n250<\/td>\n<\/tr>\n
\u00a0<\/strong><\/td>\nAbdomen (multiple incidente)<\/td>\n0.245<\/td>\n20<\/td>\n<\/tr>\n
\u00a0<\/strong><\/td>\nColoana lombosacrat\u0103<\/td>\n0.359<\/td>\n13<\/td>\n<\/tr>\n
\u00a0<\/strong><\/td>\nUrografie i.v.<\/td>\n1398<\/td>\n3<\/td>\n<\/tr>\n
\u00a0<\/strong><\/td>\nBazin<\/td>\n0.04<\/td>\n125<\/td>\n<\/tr>\n
Computer-<\/strong><\/p>\n

tomografie<\/strong><\/td>\n

<\/td>\n<\/td>\n<\/td>\n<\/tr>\n
\u00a0<\/strong><\/td>\nCraniu (10 sec\u0163iuni)<\/td>\n<0.05<\/td>\n>100<\/td>\n<\/tr>\n
\u00a0<\/strong><\/td>\nTorace (10 sec\u0163iuni)<\/td>\n<0.1<\/td>\n>50<\/td>\n<\/tr>\n
\u00a0<\/strong><\/td>\nAbdomen (10 sec\u0163iuni)<\/td>\n2600<\/td>\n1<\/td>\n<\/tr>\n
\u00a0<\/strong><\/td>\nBazin (1 sec\u0163iune)<\/td>\n0.25<\/td>\n20<\/td>\n<\/tr>\n
Radioscopie<\/strong><\/td>\n<\/td>\n<\/td>\n<\/td>\n<\/tr>\n
\u00a0<\/strong><\/td>\nTub digestiv superior<\/td>\n0.056<\/td>\n89<\/td>\n<\/tr>\n
\u00a0<\/strong><\/td>\nTranzit baritat<\/td>\n0.006<\/td>\n833<\/td>\n<\/tr>\n
\u00a0<\/strong><\/td>\nIrigografie<\/td>\n3986<\/td>\n1<\/td>\n<\/tr>\n
Explor\u0103ri cu radioizotopi<\/strong><\/td>\n<\/td>\n<\/td>\n<\/td>\n<\/tr>\n
\u00a0<\/strong><\/td>\nTc99m (majoritatea explor\u0103rilor)<\/td>\n<0.5<\/td>\n>10<\/td>\n<\/tr>\n
Radia\u0163ia din mediu<\/strong><\/td>\nRadia\u0163ia de baz\u0103 din mediu (doz\u0103 cumulat\u0103 \u00een 9 luni)<\/td>\n0.1<\/td>\n<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n

*(rad este indicat\u0103 valoarea maxim\u0103 din datele existente p\u00e2n\u0103 \u00een prezent).<\/em><\/p>\n

Multe din informa\u0163iile cu privire la efectul radia\u0163iilor asupra organismului uman provin de la femeile care au supravie\u0163uit atacurilor atomice de la Hiroshima \u0219i Nagasaki, c\u00e2nd au fost expuse la doze mari de radia\u0163ii \u0219i care la acea data erau \u00eens\u0103rcinate. [3]<\/sup><\/strong> Aceste efecte sunt grupate clasic \u00een 3 categorii: teratogeneza, carcinogeneza, mutageneza (muta\u0163ii ale genelor din celulele germinale).<\/p>\n

1.Teratogeneza<\/u><\/strong><\/p>\n

Expunerea la doze mari de radia\u0163ii determin\u0103 cel mai frecvent la nivel fetal malforma\u0163ii ale SNC, \u00een special microcefalie \u0219i retard mental. [4]<\/sup><\/strong> S-a stabilit o rela\u0163ie direct propor\u0163ional\u0103 \u00eentre doza de radia\u0163ii \u0219i retardul mental sever, cu specificarea c\u0103 cele mai multe cazuri s-au datorat expunerii la radia\u0163ii \u00eentre s\u0103pt\u0103m\u00e2nile 10-17 de gesta\u0163ie. [1]<\/sup><\/strong> Pe baza acestei rela\u0163ii, riscul malforma\u0163iilor atinge 40% la o doza de 100 rad, dar este nesemnificativ statistic la dozele generate de explor\u0103rile radiologice. P\u00e2n\u0103 c\u00e2nd se vor acumula mai multe date cu privire la acest aspect, atitudinea de urmat este evitarea explor\u0103rilor radiologice f\u0103r\u0103 caracter de urgen\u0163\u0103 \u00een cursul perioadei de risc maxim s\u0103pt\u0103m\u00e2ni 10-17 de gesta\u0163ie (8-15 s\u0103pt\u0103m\u00e2ni din momentul concep\u0163iei).<\/p>\n

2. Carcinogeneza<\/u><\/strong><\/p>\n

Expunerea la radia\u0163ii, chiar \u00een doze mici (1-2 rad), a fost asociat\u0103 cu o u\u0219oar\u0103 cre\u0219tere a inciden\u0163ei neoplaziilor infantile, \u00een special leucemia. Inciden\u0163a leucemiei \u00een popula\u0163ia general\u0103 este de 3.60\/000 iar dup\u0103 expunere la 1-2 rad o cre\u0219te la 50\/000. [5]<\/sup><\/strong> Diferen\u0163a este nesemnificativ\u0103, at\u00e2t timp c\u00e2t doza nu o dep\u0103\u0219e\u0219te pe cea generat\u0103 de explor\u0103rile radiologice uzuale. \u00cenaintea efectu\u0103rii unei explor\u0103ri radiologice, ar trebui evaluate atent riscurile \u0219i beneficiile, iar gravida ar trebui inclus\u0103 \u00een procesul decizional.<\/p>\n

III. Muta<\/u><\/strong>\u0163<\/u><\/strong>iile genice<\/u><\/strong><\/p>\n

Radia\u0163iile pot provoca muta\u0163ii ale genelor din celulele germinale, muta\u0163ii care se pot transmite descenden\u0163ilor. \u00cen ciuda p\u0103rerii generale, conform c\u0103reia radia\u0163iile ar provoca numai muta\u0163ii noi, bizare, datele acumulate p\u00e2n\u0103 \u00een prezent demonstreaz\u0103 c\u0103, de fapt, are loc numai o cre\u0219tere a frecven\u0163ei muta\u0163iilor spontane ce apar \u00een popula\u0163ia general\u0103. Doza necesar\u0103 pentru a dubla inciden\u0163a muta\u0163iilor spontane este cuprins\u0103 \u00eentre 50 \u0219i 100 rad, cu mult peste dozele generate de explor\u0103rile radiologice uzuale. Altfel spus dac\u0103 10000 de persoane ar fi expuse la o doz\u0103 de 1 rad ar apare \u00eentre 10 \u0219i 40 de muta\u0163ii genice noi.<\/p>\n

Concluzii ale unor organiza\u0163ii de specialitate cu privire la utilizarea metodelor imagistice \u00een timpul sarcinii:<\/strong><\/p>\n

1.<\/strong>Metodele bazate pe raze X\u00a0<\/u><\/strong><\/p>\n

    \n
  1. a) \u00abNici una din aceste metode nu produce o doza suficient de mare de radia\u021bii pentru a afecta dezvoltarea embrionului sau f\u0103tului\u00bb –\u00a0American College of Radiology. <\/em>[1]<\/sup><\/strong><\/li>\n
  2. b) \u201eRiscul pentru f\u0103t, comparativ cu alte afec\u0163iuni ap\u0103rute \u00een sarcin\u0103, este considerat neglijabil, la doze mai mici sau egale cu 5 rad, dar devine semnificativ la o doz\u0103 de peste 15 rad.\u00bb –\u00a0National Council on Radiation Protection. <\/em>[6]<\/sup><\/strong><\/li>\n
  3. c) \u201eFemeile ar trebui informate asupra faptului c\u0103 doza de radia\u0163ii de la o singur\u0103 explorare radiologic\u0103 nu are efecte negative asupra f\u0103tului; mai exact, o doz\u0103 mai mic\u0103 de 5 rad nu se asociaz\u0103 cu o cre\u0219tere semnificativ\u0103 a inciden\u0163ei anomaliilor fetale sau a riscului de avort spontan\u00bb –\u00a0American College of Obstetricians and Gynecologists. (ACOG). <\/em>[7]<\/sup><\/strong><\/li>\n<\/ol>\n

    2.RMN<\/u><\/strong><\/p>\n

    \u201eDe\u0219i p\u00e2n\u0103 \u00een prezent nu exist\u0103 date certe cu privire la efectele adverse asupra f\u0103tului,\u00a0National Radiological Protection Board<\/em><\/strong>\u00a0recomand\u0103 evitarea utiliz\u0103rii acestei metode \u00een primul trimestru de sarcin\u0103\u00bb –\u00a0ACOG si National Radiological Protection Board. <\/em>[7]<\/sup><\/strong><\/p>\n

    III. Ecografia<\/u><\/strong><\/p>\n

    \u201eNu exist\u0103 date certe cu privire la efectele adverse asupra f\u0103tului ale metodelor bazate pe ultrasunete, inclusiv echografia Doppler\u00bb<\/strong> –\u00a0ACOG. <\/em>[7]<\/sup><\/strong><\/p>\n

    Atunci c\u00e2nd o gravid\u0103 urmeaz\u0103 s\u0103 fie investigat\u0103 radiologic principala \u00eentrebare care o pune este dac\u0103 copilul va avea de suferit. Pentru a r\u0103spunde la aceast\u0103 \u00eentrebare medicul trebuie s\u0103-\u0219i aleag\u0103 atent cuvintele, astfel \u00eenc\u00e2t pacienta s\u0103 fie informat\u0103 corect asupra riscurilor, chiar mici, dar f\u0103r\u0103 a provoca panic\u0103. \u00cen popula\u0163ia general\u0103 inciden\u0163a cumulat\u0103 a avortului spontan, malforma\u0163iilor fetale majore, retardului mental sever \u0219i a neoplaziilor infantile este de aproximativ 286 de cazuri la 1000 de na\u0219teri. Expunerea f\u0103tului la o doz\u0103 de 0.5 rad cre\u0219te aceast\u0103 inciden\u0163\u0103 cu doar 0.17 cazuri la 1000 de na\u0219teri, sau cu 1 caz la 6000 de na\u0219teri. \u00cen cazul unei gravide care necesit\u0103 o explorare radiologic\u0103 American College of Radiology recomand\u0103 ca pacientei s\u0103 i se spun\u0103 c\u0103 examinarea respectiv\u0103 prezint\u0103 siguran\u0163\u0103 pentru copil \u0219i s\u0103 i se explice \u0219i avantajele acesteia.<\/p>\n

    De asemenea medicii ar trebui s\u0103 informeze pacientele c\u0103 uneori apar malforma\u0163ii fetale f\u0103r\u0103 o cauz\u0103 aparent\u0103. Statisticile arat\u0103 c\u0103 4-6% din noun\u0103scu\u0163i prezint\u0103 diverse malforma\u0163ii. Este important ca niciodat\u0103 s\u0103 nu li se promit\u0103 p\u0103rin\u0163ilor c\u0103 vor avea un copil perfect. Doza de radia\u0163ii primit\u0103 \u00een urma unei explor\u0103ri radiologice este pu\u0163in probabil c\u0103 va afecta f\u0103tul, totu\u0219i dac\u0103 este descoperit\u0103 o malforma\u0163ie dup\u0103 o asemenea investiga\u0163ie p\u0103rin\u0163ii vor avea tendin\u0163a de a considera radia\u0163iile drept cauz\u0103 principal\u0103. Se citeaz\u0103 cazul unei mame care a intentat o ac\u0163iune \u00een justi\u0163ie din cauz\u0103 c\u0103 a considerat c\u0103 o radiografie dentar\u0103 efectuat\u0103 \u00een trimestru III de sarcin\u0103 este responsabil\u0103 de o u\u0219oar\u0103 sindactilie la degetele 4-5 ale copilului ei. De\u0219i se poate afirma aproape cu certitudine c\u0103 a fost doar o coinciden\u0163\u0103, totu\u0219i femeia respectiv\u0103 cu greu a putut accepta aceast\u0103 explica\u0163ie.<\/p>\n

    Precau<\/u><\/strong>\u0163<\/u><\/strong>ii<\/u><\/strong><\/p>\n

    De\u0219i utilizarea metodelor radiologice \u00een sarcin\u0103 prezint\u0103 siguran\u0163\u0103, totu\u0219i trebuie \u0163inut cont \u0219i de reticen\u021bele pacientelor. Cheia pentru o rela\u0163ie medic-pacient bazat\u0103 pe \u00eencredere este o comunicare bun\u0103. De aceea, \u00eenaintea oric\u0103rei investiga\u0163ii radiologice, pacientei trebuie s\u0103 i se explice riscurile poten\u0163iale \u0219i s\u0103 i se cear\u0103 acordul scris pentru examinarea respectiv\u0103. Pentru a evita surprizele nepl\u0103cute, trebuie documentat\u0103 prezen\u0163a sarcinii la femeile care urmeaz\u0103 s\u0103 efectueze explor\u0103ri radiologice. Gravidele expuse la o doz\u0103 total\u0103 mai mare de 5 rad, sau cele care sunt \u00eengrijorate cu privire la starea f\u0103tului, ar trebui investigate suplimentar, eventual cu asisten\u0163\u0103 din partea medicului radiolog care s\u0103 estimeze doza de radia\u0163ii primit\u0103 de f\u0103t \u00een cursul unei anumite explor\u0103ri.<\/p>\n

    Dar trebuie evitat\u0103 \u0219i cealalt\u0103 extrem\u0103, a pruden\u0163ei excesive. Teama fa\u0163\u0103 de r\u0103spunderea medico-legal\u0103 nu trebuie s\u0103 re\u0163ina de la indicarea unui examen radiologic atunci c\u00e2nd este necesar. \u00abExplor\u0103rile radiologice sunt indicate \u00een sarcin\u0103 doar dac\u0103 furnizeaz\u0103 informa\u0163ii esen\u0163iale cu privire la o afec\u0163iune matern\u0103, informa\u0163ii care nu pot fi ob\u0163inute prin alte mijloace, ca de exemplu ecografia\u00bb<\/strong> –\u00a0American Academy of Pediatrics \u0219i ACOG<\/em>.<\/p>\n

    Avortul terapeutic<\/u><\/strong><\/p>\n

    Unele gravide consider\u0103 radia\u0163iile at\u00e2t de nocive \u00eenc\u00e2t apreciaz\u0103 c\u0103 \u00eentreruperea evolu\u0163iei sarcinii este unica solu\u0163ie dup\u0103 expunere de radia\u0163ii. P\u00e2n\u0103 la 25% dintre ele consider\u0103 radia\u0163iile un factor de risc pentru malforma\u0163ii fetale majore. Dup\u0103 accidentul de la Cernobil, 23 % din femeile \u00eens\u0103rcinate din Grecia au avortat din cauza temerilor nefondate cu privire la efectele teratogene asupra f\u0103tului. Consilierea la timp a pacientelor duce cel mai adesea la evitarea unor asemenea erori. Din punct de vedere medical riscul suplimentar reprezentat de o explorare radiologic\u0103 este prea mic pentru a justifica un avort terapeutic. ACOG specific\u0103 foarte clar c\u0103:\u00a0\u201eExpunerea la raze X \u00een cursul sarcinii nu reprezint\u0103 o indica\u0163ie pentru avortul terapeutic\u00bb<\/em><\/strong>.<\/p>\n

    Concluzii<\/u><\/strong><\/p>\n

    O afec\u0163iune matern\u0103 survenit\u0103 \u00een cursul sarcinii reprezint\u0103 un factor de risc at\u00e2t pentru mam\u0103 c\u00e2t \u0219i pentru f\u0103t; acest risc este aproape \u00eentotdeauna mai mare dec\u00e2t cel reprezentat de expunerea la o doz\u0103 mic\u0103 de radia\u0163ii ca urmare a unei investiga\u0163ii radiologice justificat\u0103 de respectiva afec\u0163iune. Dac\u0103 nu este o urgen\u0163\u0103, explorarea radiologic\u0103 trebuie efectuat\u0103 \u00een afara intervalului de 10-17 s\u0103pt\u0103m\u00e2ni de gesta\u0163ie, perioad\u0103 de maxim\u0103 sensibilitate \u00een dezvoltarea SNC. Dac\u0103 diagnosticul imagistic este urgent atunci prima alternativ\u0103 este ecografia a c\u0103rei utilizare prezint\u0103 siguran\u0163a pe toat\u0103 durata sarcinii. O bun\u0103 comunicare medic-pacient scade anxietatea mamei, evit\u0103 ne\u00een\u0163elegerile \u0219i ac\u0163iunile \u00een justi\u0163ie \u00een eventualitatea unei evolu\u0163ii neprev\u0103zute a sarcinii dup\u0103 o investiga\u0163ie radiologic\u0103.<\/p>\n

    Riscurile asupra dezvolt\u0103rii fetale sunt mici. Doza cumulativ\u0103 de radia\u0163ii considerat\u0103 f\u0103r\u0103 risc \u00een cursul sarcinii este 5 rad, doz\u0103 care nu este dep\u0103\u0219it\u0103 \u00een cursul nici unei explor\u0103ri radiologice. Doza primit\u0103 de f\u0103t \u00een cursul unei radiografii toracice materne (fa\u0163\u0103 \u0219i profil) este de 0,00007 rad. Perioada de risc maxim pentru malforma\u0163ii ale SNC este \u00eentre 10-17 s\u0103pt\u0103m\u00e2ni de gesta\u0163ie, de\u00a0 aceea explor\u0103rile radiologice f\u0103r\u0103 caracter de urgen\u0163\u0103 ar trebui evitate \u00een acest interval. Printre riscurile expunerii la radia\u0163ii \u00een perioada intrauterin\u0103 se citeaz\u0103 o u\u0219oar\u0103 cre\u0219tere a inciden\u0163ei leucemiei infantile \u0219i a muta\u0163iilor genetice, nefiind \u00eens\u0103 indica\u0163ii de \u00eentrerupere a cursului sarcinii. De maxim\u0103 importan\u0163\u0103 r\u0103m\u00e2ne informarea pacientelor \u00eenaintea efectu\u0103rii unor explor\u0103ri radiologice.<\/p>\n","protected":false},"excerpt":{"rendered":"

    Rezumat \u00cen timpul sarcinii pot apare diverse afec\u0163iuni materne care necesit\u0103 uneori examene radiologice pentru stabilirea diagnosticului \u0219i conduitei terapeutice. \u00cen aceste situa\u0163ii, at\u00e2t medicul c\u00e2t \u0219i gravida, \u00ee\u0219i pun […]<\/p>\n","protected":false},"author":4,"featured_media":10623,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_exactmetrics_skip_tracking":false,"_exactmetrics_sitenote_active":false,"_exactmetrics_sitenote_note":"","_exactmetrics_sitenote_category":0,"footnotes":""},"categories":[429],"tags":[],"class_list":["post-10622","post","type-post","status-publish","format-standard","has-post-thumbnail","category-ginecologie"],"yoast_head":"\nImpactul explor\u0103rilor radiologice \u00een timpul sarcinii - Jurmed - Medici<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/jurmed.ro\/medici\/impactul-explorarilor-radiologice-in-timpul-sarcinii\/\" \/>\n<meta property=\"og:locale\" content=\"ro_RO\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Impactul explor\u0103rilor radiologice \u00een timpul sarcinii - 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