Diagnosis of abdominal pain in pregnant patient can be confounded by several factors including nonspecific leukocytosis, displacement of structures by enlarging uterus, difficult abdominal examination and nonspecific nausea and vomiting 1,2. Accurate diagnosis is important as delay in diagnosis can be detrimental to both the mother and fetus 3. MR is the preferred method of imaging the abdomen after ultrasound in pregnant patients due to the lack of ionizing radiation and excellent soft tissue contrast along with the ability to evaluate multiple additional structures due to the large field of view possible.The risks related to MR imaging are teratogenic and not carcinogenic. Primary concern of MRI is heating associated with the radiofrequency pulse B0 strength which may affect cell migration during first trimester and acoustic noise produced during imaging which may damage the fetal hearing 4. The ACR Guidance document on MR safe practices states that MR imaging can be used at any gestational age when the information gathered is likely to alter treatment and when it cannot be obtained by other nonionizing exams and when the exam cannot be delayed until after delivery 5. Even though the risks of cell migration injury remain theoretical in humans and no detrimental effect has been reported, the International commission on nonionizing radiation protection (ICNIRP) recommends postponement of elective MR imaging until after first trimester 6,7.Even though there have been some reports of post-implantation fetal loss and abnormalities in animals, to date there have been no known adverse effects to human fetuses when clinically recommended dosages of gadolinium-based contrast agents (GBCAs) have been given to pregnant women 8,9. However, no well controlled studies of teratogenic effects of these media in pregnant women have been performed. Gadolinium chelate traverses the placenta and may accumulate in the amniotic cavity. The contrast medium cycles through the fetal gastrointestinal tract and genitourinary tract and can remain there for an indefinite period of time, however recent studies show that only traces of contrast remaining in the fetus after 24 hours. The free gadolinium ion is toxic to the fetus. When the gadolinium chelates accumulate in the amniotic fluid, there is the potential for dissociation of the toxic free gadolinium ion producing a potential risk for the development of nephrogenic systemic fibrosis (NSF) in the child or mother. The U.S. FDA has classified gadolinium-based agents as category C drugs. The ACR Committee on Drugs and Contrast Media published in 2015 recommended that “each case should be reviewed carefully by members of the clinical and radiology services and a GBCA should be administered only when there is a potential significant benefit to the patient or fetus that outweighs the possible but unknown risk of fetal exposure to free gadolinium ions”. They also recommend that informed consent be obtained from the patient after discussion with the referring physician. The radiologist should also document that the information requested from the MRI study cannot be acquired without the use of IV contrast and it affects the care of the patient and/or fetus. The Contrast Media Safety Committee of the European Society of Urogenital Radiology in their revised guidelines in May 2012 recommend using the smallest possible dose of one of the most stable GBCAs and only for the a very strong indication for enhanced MRI. They do not recommend any monitoring of the neonate after the mother has been given GBCA during pregnancy.The most common indication for MRI in pregnancy is acute appendicitis with a prevalence of 50-70 per 1000 patients 10,11. The biggest difference in evaluation of appendicitis in pregnant vs non-pregnant patients is the location of the appendix. Due to the pressure from the enlarging gravid uterus, the appendix is pushed superiorly into the abdomen. The risk to the fetus from a perforated appendix is approximately 20% compared to risk from surgery of about 3%. Criteria used for an abnormal appendix are similar in pregnant and non=-pregnant patients. Nonspecific abdominal pain caused by disease of the gallbladder, urinary tract, bowel, pancreas, ovary and liver can all have similar manifestations. US is the preferred initial exam of choice, however MRI can be performed in equivocal cases if necessary.