Diagnosing Pulmonary Embolism in Pregnancy: Synthesis of Current Guidelines and New Evidence

J Obstet Gynaecol Can. 2020 Dec;42(12):1546-1549. doi: 10.1016/j.jogc.2020.03.025. Epub 2020 Apr 28.

Abstract

Pulmonary embolism (PE) complicates 5.4 per 10 000 pregnancies and remains a significant cause of maternal mortality. Prompt diagnosis and treatment of PE are key to ensuring optimal outcomes, but are not without risks associated with over-testing. Given the paucity of evidence informing PE diagnosis in pregnancy, marked heterogeneity exists among different societies in their recommendations. Here we provide an overview of existing recommendations and novel evidence informing the diagnosis of PE in pregnancy, including the use of d-dimers, the choice of diagnostic imaging modality, and the potential for breast cancer risk among women exposed to ionizing radiation from computed tomography pulmonary angiography (CTPA).

Keywords: diagnosis; maternal health; pregnancy; pulmonary embolism; venous thrombosis.

MeSH terms

  • Adult
  • Clinical Decision-Making
  • Computed Tomography Angiography
  • Female
  • Fibrin Fibrinogen Degradation Products / analysis
  • Guidelines as Topic*
  • Humans
  • Pregnancy
  • Pregnancy Complications, Cardiovascular* / blood
  • Pulmonary Embolism / blood
  • Pulmonary Embolism / diagnostic imaging*
  • Time Factors

Substances

  • Fibrin Fibrinogen Degradation Products
  • fibrin fragment D