Diagnosis of Pulmonary Embolism During Pregnancy

Righini, Marc; Robert‐Ebadi, Helia; Elias, Antoine; Sanchez, Olivier; Moigne, Emmanuelle Le; Schmidt, Jeannot; Gall, Catherine Le; Cornuz, Jacques; Aujesky, Drahomir; Roy, Pierre‐Marie; Chauleur, Céline; Rutschmann, Olivier Thierry; Poletti, Pierre–Alexandre; Gal, Grégoire Le

doi:10.7326/m18-1670

Cited by 140 publications

(64 citation statements)

References 39 publications

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“…Few patients in this study population, only 4%, received a diagnosis of pulmonary embolism, similar to the prevalence found in other studies including pregnant patients. 1,2 In this case, the negative predictive value was 99.5%. However, the prevalence in studies conducted in the United States appears lower, at 2.8%, compared with just over 5% in other countries.…”

Section: Discussion Pointsmentioning

confidence: 72%

YEARS Algorithm in Pregnant Patients With Suspected Pulmonary Embolism

Westafer

2019

Annals of Emergency Medicine

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Section: Discussion Pointsmentioning

confidence: 72%

YEARS Algorithm in Pregnant Patients With Suspected Pulmonary Embolism

Westafer

2019

Annals of Emergency Medicine

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“…27 Diagnostic criteria for the management of suspected pulmonary embolism in pregnant women have largely been gleaned from studies in nonpregnant populations and retrospective studies and, thus, remain inconsistent and under debate. 29 Most guidelines recommend the use of V/Q scan over chest CT, primarily to minimize maternal radiation exposure. 30 However, a recent study 29 in 2018 reported high performance of a CT-based diagnostic strategy.…”

Section: Discussionmentioning

confidence: 99%

Trends in Medical Imaging During Pregnancy in the United States and Ontario, Canada, 1996 to 2016

et al. 2019

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IMPORTANCE The use of medical imaging has sharply increased over the last 2 decades. Imaging rates during pregnancy have not been quantified in a large, multisite study setting. OBJECTIVE To evaluate patterns of medical imaging during pregnancy. DESIGN, SETTING, AND PARTICIPANTS A retrospective cohort study was performed at 6 US integrated health care systems and in Ontario, Canada. Participants included pregnant women who gave birth to a live neonate of at least 24 weeks' gestation between January 1, 1996, and December 31, 2016, and who were enrolled in the health care system for the entire pregnancy. EXPOSURES Computed tomography (CT), magnetic resonance imaging, conventional radiography, angiography and fluoroscopy, and nuclear medicine. MAIN OUTCOMES AND MEASURES Imaging rates per pregnancy stratified by country and year of child's birth. RESULTS A total of 3 497 603 pregnancies in 2 211 789 women were included. Overall, 26% of pregnancies were from US sites. Most (92%) were in women aged 20 to 39 years, and 85% resulted in full-term births. Computed tomography imaging rates in the United States increased from 2.0 examinations/1000 pregnancies in 1996 to 11.4/1000 pregnancies in 2007, remained stable through 2010, and decreased to 9.3/1000 pregnancies by 2016, for an overall increase of 3.7-fold. Computed tomography rates in Ontario, Canada, increased more gradually by 2.0-fold, from 2.0/1000 pregnancies in 1996 to 6.2/1000 pregnancies in 2016, which was 33% lower than in the United States. Overall, 5.3% of pregnant women in US sites and 3.6% in Ontario underwent imaging with ionizing radiation, and 0.8% of women at US sites and 0.4% in Ontario underwent CT. Magnetic

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“…Pregnancy and the postpartum period confer an increased risk of venous thromboembolism, but only 4-7% of women investigated are diagnosed as having pregnancy associated pulmonary embolism 5051. Diagnosing pulmonary embolism in pregnancy is challenging, as shortness of breath and lower extremity swelling are common complaints and D-dimer concentration is increased in normal pregnancies.…”

Section: Diagnosismentioning

confidence: 99%

“…Two large observational studies specific to pregnant women have recently been published. The first evaluated the use of the modified Geneva score and a high sensitivity D-dimer in 441 pregnant patients 51. Women with a low or intermediate clinical probability and negative D-dimer (<500 μg/L) had pulmonary embolism excluded; all others underwent bilateral lower limb compression ultrasonography and, if this was negative, CTPA.…”

Section: Diagnosismentioning

confidence: 99%

Pulmonary embolism: update on management and controversies

Duffett

Castellucci

Forgie

2020

BMJ

136

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Pulmonary embolism is a common and potentially fatal cardiovascular disorder that must be promptly diagnosed and treated. The diagnosis, risk assessment, and management of pulmonary embolism have evolved with a better understanding of efficient use of diagnostic and therapeutic options. The use of either clinical probability adjusted or age adjusted D-dimer interpretation has led to a reduction in diagnostic imaging to exclude pulmonary embolism. Direct oral anticoagulation therapies are safe, effective, and convenient treatments for most patients with acute venous thromboembolism, with a lower risk of bleeding than vitamin K antagonists. These oral therapeutic options have opened up opportunities for safe outpatient management of pulmonary embolism in selected patients. Recent clinical trials exploring the use of systemic thrombolysis in intermediate to high risk pulmonary embolism suggest that this therapy should be reserved for patients with evidence of hemodynamic compromise. The role of low dose systemic or catheter directed thrombolysis in other patient subgroups is uncertain. After a diagnosis of pulmonary embolism, all patients should be assessed for risk of recurrent venous thromboembolism to guide duration of anticoagulation. Patients with a venous thromboembolism associated with a strong, transient, provoking risk factor can safely discontinue anticoagulation after three months of treatment. Patients with an ongoing strong risk factor, such as cancer, or unprovoked events are at increased risk of recurrent events and should be considered for extended treatment. The use of a risk prediction score can help to identify patients with unprovoked venous thromboembolism who can benefit from extended duration therapy. Despite major advances in the management of pulmonary embolism, up to half of patients report chronic functional limitations. Such patients should be screened for chronic thromboembolic pulmonary hypertension, but only a small proportion will have this as the explanation of their symptoms. In the remaining patients, future studies are needed to understand the pathophysiology and explore interventions to improve quality of life.

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Diagnosis of Pulmonary Embolism During Pregnancy

Abstract: This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY

Cited by 140 publications

References 39 publications

YEARS Algorithm in Pregnant Patients With Suspected Pulmonary Embolism

YEARS Algorithm in Pregnant Patients With Suspected Pulmonary Embolism

Trends in Medical Imaging During Pregnancy in the United States and Ontario, Canada, 1996 to 2016

Pulmonary embolism: update on management and controversies

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