ACUTE abdominal presentations in pregnancy (AAPP) show marked variation in imaging access, pathways and reporting across the UK, according to a national radiology survey.1
The findings highlight inconsistent out-of-hours provision and a lack of formal protocols, prompting renewed calls for UK-specific guidance.
Uneven Access to AAPP Imaging Out of Hours
AAPP refers to sudden abdominal pain during pregnancy, a common clinical scenario that can range from benign discomfort to serious pathology requiring urgent intervention.
Many cases of AAPP are mild and self-limiting, however some may indicate conditions such as ectopic pregnancy or pre-eclampsia, underlining the need for timely and accurate diagnosis to ensure favourable outcomes.2
The survey, which gathered 91 responses from 63 institutions, found that access to ultrasound and MRI is highest during weekday working hours, but drops significantly during evenings and weekends.1 In contrast, CT availability remains consistently high, with more than 95% of sites always able to provide access.
Specialist reporting follows a similar trend, with expert interpretation becoming far less accessible during on-call shifts, potentially affecting diagnostic confidence in urgent cases.1
Limited Pathways for AAPP Imaging
Formal imaging pathways and dedicated protocols for AAPP are lacking in many UK institutions.1 Respondents reported large variation in consent processes, patient information provision, and imaging techniques, including the use of contrast agents.
Differences also extend to supervision, dose protocols and reporting responsibilities, with practice often changing depending on time of day. Despite moderate-to-high confidence among radiologists in discussing imaging risks, the absence of standardised frameworks contributes to inconsistent care delivery.
Implications for AAPP Imaging Standards
Conducted between May and August 2025 among members of national radiology societies, the survey explored modality access, imaging workflows and reporting arrangements.1 The results demonstrate variability not only between institutions but within the same service across different shifts.
Notably, up to 96% of respondents indicated that formal UK-specific guidance would be beneficial, reflecting a strong consensus for a standardised workflow.
The findings underline the need for clearer national direction to support evidence-based imaging in pregnancy. Standardised guidance could help by improving consistency in reporting, and support clinicians managing complex presentations.
Forthcoming joint guidance from UK radiology bodies aims to address these gaps.1 If implemented effectively, it may reduce unwarranted variation and strengthen decision-making in AAPP imaging, ultimately supporting safer and more consistent care for pregnant patients.
References
- Wiles R et al. Imaging acute abdominal presentations in pregnancy – a British Society of Urogenital Radiology and British Society of Gastrointestinal and Abdominal Radiology survey of UK radiology practice. Clin Radiol. 2026;DOI:10.1016/j.crad.2026.107366.
- National Health Service (NHS). Stomach pain in pregnancy. Available at: https://www.nhs.uk/pregnancy/common-symptoms/stomach-pain/. Last accessed 28 April 2026.
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