Venous Thromboembolism during Pregnancy

Toglia, Marc R.; Weg, John G.

doi:10.1056/nejm199607113350207

Cited by 334 publications

(140 citation statements)

References 65 publications

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“…Precise diagnosis in pregnancy is also vital to prevent unnecessary diagnosis of PE, as treatment is associated with potential side effects to both the mother and foetus. A diagnosis of pulmonary embolus in a pregnant patient also has other important implications, including the need for long-term anticoagulation, avoidance of breast feeding if on oral anticoagulants, the potential need for prophylaxis during future pregnancies, and concern about future oral contraceptive use [4].…”

Section: Introductionmentioning

confidence: 99%

Does pregnancy affect vascular enhancement in patients undergoing CT pulmonary angiography?

et al. 2008

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The aim of this study was to evaluate whether pregnancy affects contrast enhancement within the pulmonary arteries during computed tomography pulmonary angiography (CTPA). This was a retrospective analysis of the CTPA examinations of 16 pregnant and 16 non-pregnant female patients, suspected of having an acute pulmonary embolus (PE), during the same time period. Pulmonary vascular enhancement was evaluated by measuring the CT density within the pulmonary arteries. In a blinded evaluation, subjective grading of contrast enhancement within the pulmonary arteries was also performed. There was a significant difference in arterial enhancement between the two groups, with pregnant patients having a mean pulmonary arterial density 112 HU less than patients in the control group [mean attenuation of 259.79 +/- 59.31 HU in pregnant patients versus 371.88 +/- 60.63 HU in non-pregnant patients (p < 0.001)]. The mean subjective pulmonary arterial enhancement score in the pregnant group was 8.19 +/- 2.51 versus 13.69 +/- 3.07 in the control group (p < 0.001). Pregnant women undergoing CTPA have significantly decreased pulmonary arterial enhancement compared to non-pregnant patients, probably due to the increase in cardiac output in pregnancy. We may need to reconsider how we perform CTPA in this group in order to ensure adequate opacification for diagnosis.

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Section: Introductionmentioning

confidence: 99%

Does pregnancy affect vascular enhancement in patients undergoing CT pulmonary angiography?

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%

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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“…Pregnancy is a condition that is associated with an increased risk of thrombo-embolic complications, and pulmonary embolism (PE) remains a leading cause of maternal mortality during this period [1]. The optimal imaging strategy for diagnosis of PE in pregnant patients remains controversial, and there is a lack of consensus regarding the use of CT pulmonary angiography (CTPA) or ventilation/perfusion (V/Q) scintigraphy as first line investigation.…”

Section: Introductionmentioning

confidence: 99%

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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Venous Thromboembolism during Pregnancy

Cited by 334 publications

References 65 publications

Does pregnancy affect vascular enhancement in patients undergoing CT pulmonary angiography?

Does pregnancy affect vascular enhancement in patients undergoing CT pulmonary angiography?

Pulmonary embolism in pregnancy: a diagnostic dilemma

Quality of CT pulmonary angiography for suspected pulmonary embolus in pregnancy

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