Treatment and diagnosis of pulmonary embolism in pregnancy

Abstract

When occurring during pregnancy, venous thrombo-embolism is a major cause of maternal mortality. The risk is highest in the third trimester of pregnancy and over the 6 weeks of the postpartum period. Exposure of the foetus to ionizing radiation is a concern when investigating suspected PE during pregnancy; although this concern is largely overruled by the hazards of missing a potentially fatal diagnosis. This is particularly true for pregnant patients with suspected high risk. A normal D-dimer value has the same exclusion value for PE in pregnant women as for other patients with suspected PE but is found more rarely, because plasma D-dimer levels physiologically increase throughout pregnancy. In pregnant women with suspected PE and signs and symptoms of DVT, guidelines suggest performing bilateral compression ultrasound of lower extremities. Use of lung scintigraphy as the preferred test in the setting of a normal CXR. The treatment of PE in pregnancy is based on heparin anticoagulation. Increasing experience suggests that LMWHs are safe in pregnancy, and their use is endorsed in several reports. Treatment should consist of a weight-adjusted dose of LMWH.