Ability of a single negative ultrasound to rule out deep vein thrombosis in pregnant women: A systematic review and meta‐analysis

Abstract

Background The diagnostic accuracy of ultrasound (US) for suspected lower extremity deep vein thrombosis (DVT) in nonpregnant patients has been well validated. However, in pregnant women with suspected DVT and an initial negative US, serial US is generally recommended. We aimed to determine the ability of single negative US to exclude DVT in symptomatic pregnant women. Methods Two authors independently reviewed the following databases: MEDLINE, PubMed, and EMBASE from inception until February 2019. We assessed the risk of bias using the CLARITY group tool for prognostic studies and performed a random effects meta‐analysis to report the pooled false negative rate of a single leg ultrasound. Results Eight studies (seven prospective and one retrospective) were included. An overlap among study populations was identified in four of the manuscripts. Two authors performed data re‐extraction from these hard copy research charts. Risk of bias was low for the included populations and method of measurement, and low or high for completeness of follow up. A total of 635 pregnant patients with symptoms of DVT had an initial negative US examination. Of those, six were diagnosed with DVT during repeat serial testing (0.94%) and three developed DVT or PE during 3‐month follow‐up after serial ultrasonography (0.47%). The pooled false‐negative rate of a single ultrasound was 1.27% (95% confidence interval, 0.42‐2.56), I2 = 27%. Conclusion The false‐negative rate is low with a single US for suspected DVT in pregnancy. Our results will help inform shared decision‐making around planning repeat ultrasound scans in these patients.

Rare deep vein thrombosis in pregnancy and puerperium 3 case series; upper extremities vein thrombosis, ovarian vein thrombosis, portal and superior mesenteric vein thrombosis

“…For diagnosis of Thrombosis, rapid imaging is crucial, and both Doppler and CT scans are utilized. 4,14 During pregnancy, Doppler is preferred to avoid radiation exposure, but in cases of vague abdominal pain such as ovarian vein thrombosis or SMV thrombosis, magnetic resonance imaging may be used. 15 Therefore, obstetricians should not postpone imaging studies for diagnosis.…”

Diagnosis of Venous Thromboembolism in Pregnancy

“…Reports of studies in the nonpregnant population have shown sensitivities of 97% to 100% with specificity of 98% to 99%, 23 with similar accuracy in pregnancy. 24 As previously discussed, the positive and negative predictive values are more significant in clinical practice than are sensitivity and specificity. Assuming that 10% of patients with a clinical diagnosis prove to have DVT, and assuming sensitivity and specificity of 98% and 99%, respectively, positive and negative predictive values would be 91.6% and 99.8%, respectively, considerably better than similar results for CTPA in suspected PE.…”

“…CUS is the test of choice in scenarios where there is clear evidence of unilateral thigh swelling and other potential signs or symptoms of DVT both during pregnancy and post-delivery. Reports of studies in the nonpregnant population have shown sensitivities of 97% to 100% with specificity of 98% to 99%,23 with similar accuracy in pregnancy 24…”

Deep Vein Thrombosis in Intravenous Drug Users: An Invisible Global Health Burden

“…Withholding anticoagulation after a negative MRDTI scan resulted in a failure rate of 1.7% (95% CI), which was lower than the 6.5% predefined safety threshold value, proving that MRDTI was a simple, reproducible, and feasible test for diagnosis of recurrent venous thromboembolism [ 90 ]. For ruling out suspected DVT in pregnancy, ultrasound proves to be an effective diagnostic test, based on a study revealing that a single negative ultrasound scan had a low false-negative rate [ 91 ]. In 2020, Kraaijpoel and his team demonstrated that all three imaging techniques, single limited vs. serial limited vs. whole-leg CUS, have equal failure rates.…”