Interventional radiology in the pregnant patient for obstetric and nonobstetric indications: organizational, anesthetic, and procedural issues.

PURPOSE OF REVIEW: As indications for interventional radiology procedures during pregnancy continue to expand, anesthesiologists must be aware of the indications for specific procedures as well as provide the safest possible anesthetic care to both the mother and the fetus in nontraditional environments.

RECENT FINDINGS: Among the different imaging modalities employed for interventional procedures, ultrasonography and MRI without gadolinium-based contrast are preferred because they are free of ionizing radiation. Providers continue to report cases in which interventional techniques are used in a well tolerated and effective manner. The current literature emphasizes radiation-sparing maneuvers to minimize maternal and fetal ionizing radiation exposure. Maternal physiologic changes should be considered when planning anesthetic management for interventional radiology procedures. Because most of these procedures are performed outside the operating rooms or labor and delivery suites, the anesthesiologists should familiarize themselves with the environment prior to providing anesthesia.

SUMMARY: The risk to the fetus of the imaging procedure must be weighed against the benefit to the mother of early and accurate diagnosis and treatment of the underlying pathology. As the organizational aspects of providing care become more complex, simulation, guidelines, and protocols may become important to the safe care of these patients.