Problem based review: pulmonary embolism in pregnancy

Problem based review: pulmonary embolism in pregnancy

Abstract

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.

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References

  1. 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.
  2. Lewis G. Why Mothers Die 2000-2002. Sixth Report of the Confidential Enquiries into Maternal Death. London: RCOG Press;2004.
  3. 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.
  4. 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.
  5. 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.
  6. 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.
  7. 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.
  8. 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.
  9. 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.
  10. 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.
  11. Royal College of Obstetricians and Gynaecologists. Thromboembolic disease in pregnancy and the puerperium: acute management. 2007.
  12. Ang CK, Tan TH, Walters WA, et al. Postural influence on maternal capillary oxygen and carbon dioxide tension. BMJ 1969; 4: 201–3.
  13. Gottschalk A, Stein PD, Goodman LR, et al. Overview of prospective investigation of pulmonary embolism diagnosis II. Semin Nucl Med 2002; 32: 173–182.
  14. 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.
  15. McCollough CH, Schueler BA, Atwell TD, et al. Radiation exposure and pregnancy: when should we be concerned? Radiographics 2007;27: 909–917.
  16. 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.
  17. Matthews S. Imaging pulmonary embolism in pregnancy: what is the most appropriate imaging protocol? Br J Radiol 2006; 79: 441–444.
  18. 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.
  19. Balan KK, Critchley M, Vedavathy KK, et al. The value of ventilation-perfusion imaging in pregnancy. Br J Radiol 1997; 70: 338–40.
  20. 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.
  21. 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.
  22. 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.
  23. 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.
  24. 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.
  25. 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.
  26. Cook JV, Kyriou J. Radiation from CT and perfusion scanning in pregnancy. BMJ 2005; 331: 350.

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Problem based review: pulmonary embolism in pregnancy

8th March 2016
PMID: 24364058
Authors Affiliations
Francesca Neuberger StR 6 Acute and General Medicine Severn Deanery Email: fneuberger@ doctors.net.uk
Nic Wennike FRCP; Taunton and Somerset NHS Foundation Trust

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

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