Working in the cardiac catheterization lab until their maternity leave began: Dr. Henrike Hillmann (left) and PD Dr. Johanna Müller-Leisse. Credit: Johanna Müller-Leisse/MHH

When female physicians are expecting a child, blanket bans on certain activities—such as surgeries and examinations involving X-rays—are often imposed. This suspension frequently results in a career setback. "For many of our female colleagues, this is a major issue. They enjoy their work, simply want to continue their current duties, or do not want to have to interrupt their specialty training," explains Dr. David Duncker, director of the Hannover Heart Rhythm Center (HHC).

The HHC is one of the few cardiology training centers in Germany that have established structures allowing female physicians to continue practicing as usual during pregnancy. The HHC is part of the Department of Cardiology and Angiology at the Hannover Medical School (MHH).

Additional protective measures

The Hannover Heart Rhythm Center offers the full range of treatments for patients with cardiac arrhythmias. This includes invasive procedures such as catheter ablations and the implantation of pacemakers and defibrillators. These are performed under X-ray guidance in the cardiac catheterization laboratory. "According to current recommendations from professional societies, pregnant physicians are permitted to continue performing invasive procedures under certain conditions and on a voluntary basis," explains Duncker.

To ensure safe working conditions, the HHC has established additional protective measures for pregnant physicians performing invasive procedures. These include the use of two-piece X-ray aprons, sterile radiation shielding drapes and an electronic real-time dosimeter to monitor radiation exposure during the procedure. To protect against infections, all patients are tested for HIV and hepatitis B. In addition, the entire team supports their pregnant colleagues. Everyone is informed and aware of the situation—if necessary, someone with at least equivalent qualifications will step in.

Safety and support from the team

Two female physicians have already had positive experiences with the new structures. Both continued to work as usual in the cardiac catheterization lab during their pregnancies—one in 2023 and the other this year. Private lecturer (PD) Dr. Johanna Müller-Leisse was thus able to gain even more experience and has since completed her habilitation; Dr. Henrike Hillmann was able to complete her residency and specialization.

For both of them, the electronic live dosimeter was particularly important. "The device is worn under the radiation protection apron, directly on the lower abdomen at the level of the uterus. It showed me that I wasn't exposed to radiation there. That gave me a great deal of reassurance," says Hillmann in retrospect. The two cardiologists also greatly appreciate the support from the team.

Study: Radiation dose to the uterus is negligibly low

The risk of radiation exposure is a concern for many pregnant female physicians. For this reason, a team at the HHC conducted an observational study to examine this issue in depth. The aim of the study was to monitor a pregnant female physician performing invasive procedures in the cardiac catheterization lab.

Over a period of 80 weeks—equivalent to the duration of two pregnancies—an electronic personal dosimeter was worn under the X-ray protective apron at the level of the uterus during all procedures performed in the catheterization lab. The device measured the total radiation potentially delivered to the uterus during the examinations over this period. During the first 40 weeks, 320 procedures were recorded, and during the second 40 weeks, 368 procedures were recorded.

The results are reassuring. "The average cumulative radiation exposure to the uterus is 0.037 millisieverts over the entire duration of a pregnancy," explains Müller-Leisse, the study's first author. "This dose is well below the permitted European limit of 1 millisievert and, in my view, is entirely acceptable." By way of comparison, the radiation exposure from a round-trip transatlantic flight is approximately 0.1 millisievert.

Topic generates significant interest

The study was published in the journal Circulation. "We hope that the data from our study can help women decide whether or not they wish to continue their interventional work during pregnancy," says Müller-Leisse. Duncker places great importance on equal opportunity within the team. For the past two years, the HHC has held the maternity protection seal "Pregnant? Here, they can continue their medical work appropriately" from the German Association of Female Physicians.

The new structures at the HHC and the study are also attracting a great deal of attention at other hospitals in Germany and Europe. "Our model is proving effective and may help other institutions find new ways to continue employing pregnant female physicians as well," says the director of the HHC.

More information: Johanna Mueller-Leisse et al, Occupational Radiation Safety in Electrophysiology During Pregnancy: Evaluating Uterine Radiation Doses During Catheter Ablations and Device Implantations, Circulation (2026). DOI: 10.1161/circulationaha.126.080556

Provided by Hannover Medical School

Source: MedicalXpress

Original article: https://medicalxpress.com/news/2026-10-heart-procedures-shielding-uterine-pregnancy.html