Use of imaging for investigation of suspected pulmonary embolism during pregnancy and the postpartum period

Scott, Katherine, Rutherford, Natalie, Fagermo, Narelle and Lust, Karin (2011) Use of imaging for investigation of suspected pulmonary embolism during pregnancy and the postpartum period. Obstetric Medicine, 4 1: 20-23. doi:10.1258/om.2010.100065


Author Scott, Katherine
Rutherford, Natalie
Fagermo, Narelle
Lust, Karin
Title Use of imaging for investigation of suspected pulmonary embolism during pregnancy and the postpartum period
Journal name Obstetric Medicine   Check publisher's open access policy
ISSN 1753-495X
1753-4968
Publication date 2011-03
Sub-type Article (original research)
DOI 10.1258/om.2010.100065
Open Access Status
Volume 4
Issue 1
Start page 20
End page 23
Total pages 4
Place of publication London, United Kingdom
Publisher Sage Publications
Language eng
Formatted abstract
Pulmonary embolism (PE) is recognized as a leading cause of maternal mortality in the developed world; however, it is a very difficult diagnosis to make on clinical grounds, and in most cases imaging is required. Pregnancy is a recognized risk factor for venous thromboembolism, and symptoms of normal pregnancy including shortness of breath, tachycardia and leg swelling are included in clinical tools for risk stratification for PE in the non-pregnant population. This results in a very low threshold for imaging, despite concerns regarding the risk of exposure to ionizing radiation both for the fetus and the maternal breast. We reviewed the results of all ventilation/perfusion scans and computed tomography pulmonary angiograms performed in pregnant women at a single institution to identify how many of these tests were positive for PE, and which clinical features may identify a low-risk group. A total of 386 scans were performed to investigate 375 episodes of suspected PE, representing 1.3–1.5% of pregnant women. Fifteen patients were diagnosed with PE, giving an incidence of one in 2000 maternities. The only statistically significant factors associated with PE were smoking or the presence of multiple risk factors. Clinical features of tachycardia and leg swelling did not provide significant diagnostic value; however, the absence of pleuritic chest pain had a negative predictive value of 97.8%. Arterial blood gas and D-dimer were statistically different between those with and without PE but not to a clinically useful degree. Currently available clinical and laboratory tools are not adequate to exclude a diagnosis of PE in a pregnant patient, thus imaging is justified to exclude PE. Further longitudinal studies to identify a low-risk group who do not require imaging is vital.
Keyword Pulmonary embolism
Venous thromboembolism (VTE)
Pregnancy
Risk factors
CT pulmonary angiogram (CTPA)
Ventilation/perfusion scan (VQ)
Investigations
Q-Index Code C1
Q-Index Status Provisional Code
Institutional Status Non-UQ

Document type: Journal Article
Sub-type: Article (original research)
Collection: School of Medicine Publications
 
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Created: Tue, 04 Mar 2014, 14:08:03 EST by Karin Lust on behalf of Medicine - Royal Brisbane and Women's Hospital