European Radiology

, Volume 23, Issue 12, pp 3485–3500 | Cite as

Acute abdominal and pelvic pain in pregnancy: ESUR recommendations

  • Gabriele MasselliEmail author
  • Lorenzo Derchi
  • Josephine McHugo
  • Andrea Rockall
  • Peter Vock
  • Michael Weston
  • John Spencer
  • ESUR Female Pelvic Imaging Subcommittee


Acute abdominal pain in pregnancy presents diagnostic and therapeutic challenges. Standard imaging techniques need to be adapted to reduce harm to the fetus from X-rays due to their teratogenic and carcinogenic potential. Ultrasound remains the primary imaging investigation of the pregnant abdomen. Magnetic resonance imaging (MRI) has been shown to be useful in the diagnosis of gynaecological and obstetric problems during pregnancy and in the setting of acute abdomen during pregnancy. MRI overcomes some of the limitations of ultrasound, mainly the size of the gravid uterus. MRI poses theoretical risks to the fetus and care must be taken to minimise these with the avoidance of contrast agents. This article reviews the evolving imaging and clinical literature on appropriate investigation of acute abdominal and pelvic pain during established intrauterine pregnancy, addressing its common causes. Guidelines based on the current literature and on the accumulated clinico-radiological experience of the European Society of Urogenital Radiology (ESUR) working group are proposed for imaging these suspected conditions.

Key Points

Ultrasound and MRI are the preferred investigations for abdominal pain during pregnancy.

Ultrasound remains the primary imaging investigation because of availability and portability.

MRI helps differentiate causes of abdominopelvic pain when ultrasound is inconclusive.

If MRI cannot be performed, low-dose CT may be necessary.

Following severe trauma, CT cannot be delayed because of radiation concerns.


Acute abdominal pain Pregnancy Guidelines Ultrasound Magnetic resonance 


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Copyright information

© European Society of Radiology 2013

Authors and Affiliations

  • Gabriele Masselli
    • 1
    • 7
    Email author
  • Lorenzo Derchi
    • 2
  • Josephine McHugo
    • 3
  • Andrea Rockall
    • 4
  • Peter Vock
    • 5
  • Michael Weston
    • 6
  • John Spencer
    • 6
  • ESUR Female Pelvic Imaging Subcommittee
  1. 1.Department of RadiologyPoliclinico Umberto I. Sapienza University RomeRomeItaly
  2. 2.Department of RadiologySan Martino Hospital, University of GenovaGenovaItaly
  3. 3.Department of RadiologyBirmingham Women’s HospitalBirminghamUK
  4. 4.Department of RadiologyImperial College LondonLondonUK
  5. 5.Department of Diagnostic RadiologyInselspital BernBernSwitzerland
  6. 6.Department of RadiologySt James’s University HospitalLeedsEngland
  7. 7.First Faculty of Medicine, Radiology DepartmentUniversità di Roma SapienzaRomeItaly

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