Incidence, clinical characteristics, and timing of objectively diagnosed venous thromboembolism during pregnancy

Gherman, Robert B.; Goodwin, T. Murphy; Leung, Belinda; Byrne, James D.; Montoro, Martin

doi:10.1016/s1068-607x(98)00044-4

Cited by 79 publications

(130 citation statements)

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“…Despite the increased risk of thrombo-embolic complications, the actual incidence of pulmonary embolism is still relatively low in pregnancy, with large series reporting an incidence of approximately 0.01%, equivalent to roughly one in every 10,000 pregnancies [16]. It is not surprising therefore that in our series none of the CTPA studies in the pregnant group was positive.…”

Section: Discussionmentioning

confidence: 46%

Quality of CT pulmonary angiography for suspected pulmonary embolus in pregnancy

et al. 2008

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The main objective of this study was to assess the quality of CT pulmonary angiography (CTPA) for suspected pulmonary embolus (PE) in the pregnant population. We retrospectively identified 40 consecutive pregnant patients who underwent CTPA from January 2005 to December 2006. Forty consecutive age-matched non-pregnant women were used as a control group. Studies were subjectively graded according to overall image quality by two readers in consensus, in randomised and blinded manner. Moreover, contrast enhancement of pulmonary arteries was subjectively and objectively evaluated. The proportion of sub-optimal studies was more than three times higher in the pregnant group (27.5%, n = 11) compared with the non-pregnant group (7.5%, n = 3; p = 0.015). Mean contrast enhancement was consistently higher in the non-pregnant group compared with pregnant group, both subjectively and objectively. The percentage of inadequately opacified vascular segments was more than two times higher in the pregnant group (28.7%, n = 264) than in the non-pregnant group (13.3%, n = 122; p = 0.0001). The incidence of sub-optimal CTPA studies is higher in pregnancy when compared with an age-matched non-pregnant control group. In addition to radiation issues, this should also be considered when implementing diagnostic strategies for suspected PE in pregnancy.

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Section: Discussionmentioning

confidence: 46%

Quality of CT pulmonary angiography for suspected pulmonary embolus in pregnancy

et al. 2008

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“…Additional damage to the pelvic vessels results from normal or assisted or operative deliveries. Multiple clotting factors are elevated in the blood during pregnancy and the puerperium, including factors I, II, VII, VIII, IX and X [2,7]. It has also been found that levels of anticoagulant protein S declines with increasing gestation [8].…”

Section: Pathophysiologymentioning

confidence: 99%

“…It has also been found that levels of anticoagulant protein S declines with increasing gestation [8]. Platelet activation and fibrin generation are increased and fibrinolytic activity is decreased predominantly in the third trimester [2,7].…”

Section: Pathophysiologymentioning

confidence: 99%

“…The incidence of venous thromboembolism (VTE) in pregnant women is estimated to be 5-12 events/10,000 pregnancies antenatally and 3-7 events/10,000 deliveries in the postpartum period [2,3] The risk of VTE events is similar in all three trimesters [4] The diagnosis of PE is not simple in the general population, but gets further complicated in pregnancy as some of the clinical symptoms of PE can be normal/expected symptoms of pregnancy. Furthermore, precise diagnosis of PE in pregnancy is vital to prevent unnecessary treatment of PE, as treatment is associated with side effects for both the mother and fetus, and also missing the diagnosis (false negative result) is associated with mortality rate as high as 30% [5] In this review, we will go through the essential steps for the diagnosis of PE, radiation exposure and hazards to the fetus and mother from radiation-based diagnostic tests.…”

Section: Introductionmentioning

confidence: 99%

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Pulmonary embolism in pregnancy: a diagnostic dilemma

et al. 2011

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The diagnosis of PE in pregnancy poses a challenge due to pregnancy-related physiological changes. Missing the PE or wrongly treating a pregnant woman for PE has serious clinical consequences. There has been concern over the use of radiation-based imaging modalities due to risk of teratogenicity and oncogenicity. This review is focused on various diagnostic options and risks of radiation to the fetus and mother from radiation-based procedures.

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“…The annual incidence of VTE during pregnancy is approximately one per 1,000 pregnancies, 7-10 times higher than outside of pregnancy [3]. The risk of VTE is similar in all three trimesters, and the left leg is mainly involved because of the compression of the left iliac vein by the right iliac artery [3][4][5]. In the puerperium, defined as the 6 week period after delivery, the daily risk of VTE is 10 times higher than in pregnancy [6].…”

Section: Introductionmentioning

confidence: 99%

The “Pregnancy Health-care Program” for the prevention of venous thromboembolism in pregnancy

et al. 2014

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Venous thromboembolism (VTE), i.e., deep vein thrombosis and pulmonary embolism, are among the main causes of morbidity and mortality in pregnancy with an estimated incidence of 1 per thousand women years. Recommendations on antithrombotic prophylaxis are weak. The aim of the "Pregnancy Health-care Program" (PHP) was to evaluate the individual risk of VTE in a cohort of pregnant women, and manage them with the aim of reducing the rate of VTE. The study was conducted from Jan 2008 to Dec 2010 in the hospital and obstetrical outclinics in Cremona, Italy, and included 1,787 pregnant women who received clinical observation (n = 1,197), above-knee compression stockings (n = 437) or compression stockings and low-molecular-weight heparin (LMWH) (n = 85) depending on their individual VTE risk, evaluated with a risk score (0.5-3.0) derived from the relative risk estimates of a number of risk factors. Visits were scheduled at the end of each trimester and at hospital discharge after delivery. No VTE occurred, but one superficial vein thrombosis was observed 3 days after vaginal delivery in a woman who received clinical observation (0.6 per thousand). No bleeding was observed in LMWH users. The PHP based on stratification of individual VTE risk resulted in a low incidence of VTE events.

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Incidence, clinical characteristics, and timing of objectively diagnosed venous thromboembolism during pregnancy

Cited by 79 publications

References 0 publications

Quality of CT pulmonary angiography for suspected pulmonary embolus in pregnancy

Quality of CT pulmonary angiography for suspected pulmonary embolus in pregnancy

Pulmonary embolism in pregnancy: a diagnostic dilemma

The “Pregnancy Health-care Program” for the prevention of venous thromboembolism in pregnancy

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