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Hi all,

I have a pregnant patient who I would like to have xrays. What are the rules for this? Is it a definite no-go?

She has a hyperkeratotic lesion under the 4th metatarsal head that is not a VP but looks like a corn, only it is exquisitely tender to the least debridement. Three months ago she injured her foot (hyperextended or hyperflexed the digits - she can't remember) apparently quite badly but did not seek medical attention. She also had a metallic splinter in her foot around the same time.

I would like to rule out bony pathology and metallic foreign body via x-ray. Or should I provide in-shoe deflection until after the birth?

Thanks for your help.

Rebecca

 

Hi Rebecca,

Will the plain films change your treatment plan in the interim? How pregnant is she? Is a diagnostic U/S out of the question instead?

 

Hi Paul,

She's 7-8 months pregnant. Is this relevant, as in, is it not as big a deal to xray later in the pregnancy (for my future reference).

Will it change my treatment plan: well it depends on what the xrays show. If there's a foreign body it probably needs to come out (now or later I don't know), for which I will refer to her GP. If there is a bony fragment I guess that will be addressed after the birth if something surgical has to be done.

All I can do is provide deflection but make sure it is investigated further at some point. I'm anticipating the patient will be pushing for a diagnosis.

I'm not sure.

Rebecca

 

Hi Rebecca,

http://www.radiologyinfo.org/en/safety/index.cfm?pg=sfty_xray#6

In your position I would write to the GP with my concerns regarding this patients foot problems & given the advanced stage of pregnancy I would request x-rays after the patient delivers.

Unless you believe there to be a potentially sinister lesion to be causing her pain I would deflect with a simple device until baby arrives.

Just my thoughts.

Regards,

Mandy.

 

Yes its relevant to some degree - if she is that far along you may consider waiting. Is it relevant to exposure, no. Xrays should be avoided during pregnancy at all costs unless absolutely necessary.

If it is a foreign body it will show on diagnostic U/S - no xray required. If it is osseous you wont be addressing it until after she gives birth, so xrays not needed until then anyhow.

My advice based on your response above - U/S her and view it that way. No issues with radiation exposure. I would imagine nearly any intervention will wait until she has given birth anyhow.

Hope it helps.

 

Thanks Paul and Twirly, your advice makes perfect sense - I have referred her for ultrasound and provided deflection.

Rebecca