Pulmonary embolism (PE) in pregnancy carries a significant mortality. Pregnant patients often present via the acute medical take with symptoms of possible PE and require timely assessment and investigation. The symptoms of PE are sometimes very difficult to differentiate from those of normal pregnancy and the vast majority of patients will require imaging. The radiation risks to mother and foetus from imaging may cause considerable anxiety (to both patients and healthcare providers) and need to be explained to patients in the context of a potentially life-threatening condition so they can be actively involved in decision-making on how best to proceed. When PE is diagnosed in pregnancy, there are obstetric considerations around the time of delivery and women should receive specialist follow-up.
Romero A, Alonso C, Rincon M, et al. Risk of venous thromboembolic disease in women A qualitative systematic review. Eur J Obstet Gynecol Reprod Biol 2005; 121(1): 8–17.
Lewis G. Why Mothers Die 2000-2002. Sixth Report of the Confidential Enquiries into Maternal Death. London: RCOG Press;2004.
Pahad JK, Litmanovich D, Pedrosa I, et al. Imaging patients with suspected pulmonary embolus; what the radiologist needs to know. Radiographics 2009; 29: 639–654.
Lewis G. (Ed.) (2007) The Confidential Enquiry into Maternal and Child Health (CEMACH): Saving mothers lives. Reviewing maternal deaths to make motherhood safer 2003-2005. The seventh report on Confidential Enquiry into Maternal Deaths in the United Kingdom. London. CEMACH.
Gherman RB, Goodwin TM, Leung B, et al. Incidence, clinical characteristics, and timing of objectively diagnosed venous thromboembolism during pregnancy. Obstet Gynecol 1999; 94: 730–734.
Heit JA, Kobbervig CE, James AH, et al. Trends in the incidence of venous thromboembolism during pregnancy or postpartum: a 30-year population-based study. Arch Intern Med. 2005; 143(10): 697–706.
Gherman RB, Goodwin TM, Leung B, et al. Incidence, clinical characteristics, and timing of objectively diagnosed venous thromboembolism during pregnancy. Obstet Gynecol 1999; 94: 730–73.
Cahill AG, Stout MJ, Macones GA, et al. Diagnosing pulmonary embolism in pregnancy using computer-tomographic angiography or ventilation-perfusion. Obstet Gynecol 2009; 114: 124–129.
Wells PS, Anderson DR, Rodger M, et al. Excluding pulmonary embolism at the bedside without diagnostic imaging: management of patients with suspected pulmonary embolism presenting to the emergency department by using a simple clinical model and d-dimer, Ann Intern Med 2001; 135: 98–107.
Chan WS, Ray JG, Murray S, et al. Suspected Pulmonary Embolism in Pregnancy. Clinical presentation, results of lung scanning, and subsequent maternal and pediatric outcomes. Arch Intern Med 2002; 162(10): 1170–1175.
Royal College of Obstetricians and Gynaecologists. Thromboembolic disease in pregnancy and the puerperium: acute management. 2007.
Ang CK, Tan TH, Walters WA, et al. Postural influence on maternal capillary oxygen and carbon dioxide tension. BMJ 1969; 4: 201–3.
Gottschalk A, Stein PD, Goodman LR, et al. Overview of prospective investigation of pulmonary embolism diagnosis II. Semin Nucl Med 2002; 32: 173–182.
Daftary A, Gregory M, Seibyl JP, et al. Chest radiograph as a triage tool in the imaging-based diagnosis of pulmonary embolism. AJR Am J Roentgenol 2005; 185: 132–134.
McCollough CH, Schueler BA, Atwell TD, et al. Radiation exposure and pregnancy: when should we be concerned? Radiographics 2007;27: 909–917.
Leung AN, Bull TM, Jaeschke R, et al. An official American Thoracic Society/ Society of Thoracic Radiology clinical practice guideline: Evaluation of suspected pulmonary embolism in pregnancy. 2011.
Matthews S. Imaging pulmonary embolism in pregnancy: what is the most appropriate imaging protocol? Br J Radiol 2006; 79: 441–444.
Righini M, Le Gal G, Aujesky D, et al. Diagnosisof pulmonary embolism by multidetectorCT alone or combined with venousultrasonography of the leg: a randomised noninferiority trial. Lancet 2008; 371: 134–1352.
Balan KK, Critchley M, Vedavathy KK, et al. The value of ventilation-perfusion imaging in pregnancy. Br J Radiol 1997; 70: 338–40.
Lifetime risk was calculated using 2010 data for females and 2008-2010 data for males by the Statistical Information Team at Cancer Research UK, 2012.
U-King-Im JM, Freeman SJ, Boylan T, et al. Quality of CT pulmonary angiography for suspected pulmonary embolus in pregnancy. Eur Radiol 2008; 18(12): 2709–15.
Andreou AK, Curtin JJ, Wilde S, et al. Does pregnancy affect vascular enhancement in patients undergoing CT pulmonary angiography? Eur Radiol. 2008; 18(12): 2716–22.
Ahearn GS, Hadjiliadis D, Govert JA, et al. Massive pulmonary embolism during pregnancy successfully treated with recombinant tissue plasminogen activator. Arch Int Med 2002; 162: 1221–7.
Venous thromboembolic diseases: the management of venous thromboembolic diseases and the role of thrombophilia testing. NICE clinical guideline 144. National Institute for Health and Clinical Excellence. 2012.
Management of massive and submassive pulmonary embolism, ileofemoral deep vein thrombosis, and chronic thromboembolic pulmonary hypertension: a scientific statement from the American Heart Association. Circulation. 2011; 123: 1788–1830.
Cook JV, Kyriou J. Radiation from CT and perfusion scanning in pregnancy. BMJ 2005; 331: 350.
Pulmonary embolism (PE) in pregnancy carries a significant mortality. Pregnant patients often present via the acute medical take with symptoms of possible PE and require timely assessment and investigation. The symptoms of PE are sometimes very difficult to differentiate from those of normal pregnancy and the vast majority of patients will require imaging. The radiation risks to mother and foetus from imaging may cause considerable anxiety (to both patients and healthcare providers) and need to be explained to patients in the context of a potentially life-threatening condition so they can be actively involved in decision-making on how best to proceed. When PE is diagnosed in pregnancy, there are obstetric considerations around the time of delivery and women should receive specialist follow-up.
Romero A, Alonso C, Rincon M, et al. Risk of venous thromboembolic disease in women A qualitative systematic review. Eur J Obstet Gynecol Reprod Biol 2005; 121(1): 8–17.
Lewis G. Why Mothers Die 2000-2002. Sixth Report of the Confidential Enquiries into Maternal Death. London: RCOG Press;2004.
Pahad JK, Litmanovich D, Pedrosa I, et al. Imaging patients with suspected pulmonary embolus; what the radiologist needs to know. Radiographics 2009; 29: 639–654.
Lewis G. (Ed.) (2007) The Confidential Enquiry into Maternal and Child Health (CEMACH): Saving mothers lives. Reviewing maternal deaths to make motherhood safer 2003-2005. The seventh report on Confidential Enquiry into Maternal Deaths in the United Kingdom. London. CEMACH.
Gherman RB, Goodwin TM, Leung B, et al. Incidence, clinical characteristics, and timing of objectively diagnosed venous thromboembolism during pregnancy. Obstet Gynecol 1999; 94: 730–734.
Heit JA, Kobbervig CE, James AH, et al. Trends in the incidence of venous thromboembolism during pregnancy or postpartum: a 30-year population-based study. Arch Intern Med. 2005; 143(10): 697–706.
Gherman RB, Goodwin TM, Leung B, et al. Incidence, clinical characteristics, and timing of objectively diagnosed venous thromboembolism during pregnancy. Obstet Gynecol 1999; 94: 730–73.
Cahill AG, Stout MJ, Macones GA, et al. Diagnosing pulmonary embolism in pregnancy using computer-tomographic angiography or ventilation-perfusion. Obstet Gynecol 2009; 114: 124–129.
Wells PS, Anderson DR, Rodger M, et al. Excluding pulmonary embolism at the bedside without diagnostic imaging: management of patients with suspected pulmonary embolism presenting to the emergency department by using a simple clinical model and d-dimer, Ann Intern Med 2001; 135: 98–107.
Chan WS, Ray JG, Murray S, et al. Suspected Pulmonary Embolism in Pregnancy. Clinical presentation, results of lung scanning, and subsequent maternal and pediatric outcomes. Arch Intern Med 2002; 162(10): 1170–1175.
Royal College of Obstetricians and Gynaecologists. Thromboembolic disease in pregnancy and the puerperium: acute management. 2007.
Ang CK, Tan TH, Walters WA, et al. Postural influence on maternal capillary oxygen and carbon dioxide tension. BMJ 1969; 4: 201–3.
Gottschalk A, Stein PD, Goodman LR, et al. Overview of prospective investigation of pulmonary embolism diagnosis II. Semin Nucl Med 2002; 32: 173–182.
Daftary A, Gregory M, Seibyl JP, et al. Chest radiograph as a triage tool in the imaging-based diagnosis of pulmonary embolism. AJR Am J Roentgenol 2005; 185: 132–134.
McCollough CH, Schueler BA, Atwell TD, et al. Radiation exposure and pregnancy: when should we be concerned? Radiographics 2007;27: 909–917.
Leung AN, Bull TM, Jaeschke R, et al. An official American Thoracic Society/ Society of Thoracic Radiology clinical practice guideline: Evaluation of suspected pulmonary embolism in pregnancy. 2011.
Matthews S. Imaging pulmonary embolism in pregnancy: what is the most appropriate imaging protocol? Br J Radiol 2006; 79: 441–444.
Righini M, Le Gal G, Aujesky D, et al. Diagnosisof pulmonary embolism by multidetectorCT alone or combined with venousultrasonography of the leg: a randomised noninferiority trial. Lancet 2008; 371: 134–1352.
Balan KK, Critchley M, Vedavathy KK, et al. The value of ventilation-perfusion imaging in pregnancy. Br J Radiol 1997; 70: 338–40.
Lifetime risk was calculated using 2010 data for females and 2008-2010 data for males by the Statistical Information Team at Cancer Research UK, 2012.
U-King-Im JM, Freeman SJ, Boylan T, et al. Quality of CT pulmonary angiography for suspected pulmonary embolus in pregnancy. Eur Radiol 2008; 18(12): 2709–15.
Andreou AK, Curtin JJ, Wilde S, et al. Does pregnancy affect vascular enhancement in patients undergoing CT pulmonary angiography? Eur Radiol. 2008; 18(12): 2716–22.
Ahearn GS, Hadjiliadis D, Govert JA, et al. Massive pulmonary embolism during pregnancy successfully treated with recombinant tissue plasminogen activator. Arch Int Med 2002; 162: 1221–7.
Venous thromboembolic diseases: the management of venous thromboembolic diseases and the role of thrombophilia testing. NICE clinical guideline 144. National Institute for Health and Clinical Excellence. 2012.
Management of massive and submassive pulmonary embolism, ileofemoral deep vein thrombosis, and chronic thromboembolic pulmonary hypertension: a scientific statement from the American Heart Association. Circulation. 2011; 123: 1788–1830.
Cook JV, Kyriou J. Radiation from CT and perfusion scanning in pregnancy. BMJ 2005; 331: 350.
To request copyright permission to republish or share portions of our works, please visit Copyright Clearance Center’s (CCC) Marketplace website by clicking the button below:
Problem based review: pulmonary embolism in pregnancy
Cite this article as:
Neuberger F, Wennike N. Problem based review: pulmonary embolism in pregnancy. Acute Med. 2013;12(4):239-45. PMID: 24364058.
Problem based review: pulmonary embolism in pregnancy
Share this article
Click the icon of the social media platform on which you would like to share this article.
Shopping Basket
We use cookies on our website to give you the most relevant experience by remembering your preferences and repeat visits. By clicking “Accept All”, you consent to the use of ALL the cookies. For more information, please visit our privacy and cookies policy.
This website uses cookies to improve your experience while you navigate through the website. Out of these, the cookies that are categorized as necessary are stored on your browser as they are essential for the working of basic functionalities of the website. We also use third-party cookies that help us analyze and understand how you use this website. These cookies will be stored in your browser only with your consent. You also have the option to opt-out of these cookies. But opting out of some of these cookies may affect your browsing experience.
Necessary cookies are absolutely essential for the website to function properly. These cookies ensure basic functionalities and security features of the website, anonymously.
Cookie
Duration
Description
cookielawinfo-checkbox-analytics
11 months
This cookie is set by GDPR Cookie Consent plugin. The cookie is used to store the user consent for the cookies in the category "Analytics".
cookielawinfo-checkbox-functional
11 months
The cookie is set by GDPR cookie consent to record the user consent for the cookies in the category "Functional".
cookielawinfo-checkbox-necessary
11 months
This cookie is set by GDPR Cookie Consent plugin. The cookies is used to store the user consent for the cookies in the category "Necessary".
cookielawinfo-checkbox-others
11 months
This cookie is set by GDPR Cookie Consent plugin. The cookie is used to store the user consent for the cookies in the category "Other.
cookielawinfo-checkbox-performance
11 months
This cookie is set by GDPR Cookie Consent plugin. The cookie is used to store the user consent for the cookies in the category "Performance".
viewed_cookie_policy
11 months
The cookie is set by the GDPR Cookie Consent plugin and is used to store whether or not user has consented to the use of cookies. It does not store any personal data.
Functional cookies help to perform certain functionalities like sharing the content of the website on social media platforms, collect feedbacks, and other third-party features.
Performance cookies are used to understand and analyze the key performance indexes of the website which helps in delivering a better user experience for the visitors.
Analytical cookies are used to understand how visitors interact with the website. These cookies help provide information on metrics the number of visitors, bounce rate, traffic source, etc.
Advertisement cookies are used to provide visitors with relevant ads and marketing campaigns. These cookies track visitors across websites and collect information to provide customized ads.