Diagnosing Pulmonary Embolism During Pregnancy: Which Test Is Best?
Authors: Anne Marie Valente, Katherine E. Economy
Journal: Annals of Internal Medicine (2018)

Editorials4 December 2018Diagnosing Pulmonary Embolism During Pregnancy: Which Test Is Best?Anne Marie Valente, MD and Katherine E. Economy, MDAnne Marie Valente, MDBrigham and Women's Hospital and Boston Children's Hospital, Boston, Massachusetts (A.M.V.)Search for more papers by this author and Katherine E. Economy, MDBrigham and Women's Hospital, Boston, Massachusetts (K.E.E.)Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/M18-2818 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail Pulmonary embolism (PE) is associated with significant morbidity and mortality in pregnant women. However, the choice of diagnostic test is often uncertain and is highly dependent on institutional availability and expertise, and guidelines for evaluation of PE in pregnant women are limited. Further, clinical trials evaluating diagnosis and management of PE frequently exclude pregnant women, and the few existing guidelines are often based on a small number of observational studies. As a result, regional practice varies widely (1).Clinical prediction rules that are commonly used to determine pretest probability of PE have not been validated in pregnant women. The Wells ...References1. Wan T, Skeith L, Karovitch A, Rodger M, Le Gal G. Guidance for the diagnosis of pulmonary embolism during pregnancy: consensus and controversies. Thromb Res. 2017;157:23-8. [PMID: 28686913] doi:10.1016/j.thromres.2017.06.025 CrossrefMedlineGoogle Scholar2. Fijalkowska A, Szczerba E, Szewczyk G, Budaj-Fidecka A, Burakowski J, Sobkowicz B, et al; Investigators ZATPOL Registry. Pregnancy as a predictor of deviations from the recommended diagnostic pathway in women with suspected pulmonary embolism: ZATPOL registry data. Arch Med Sci. 2018;14:838-45. 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Imaging in acute pulmonary embolism with special clinical scenarios. Circ Cardiovasc Imaging. 2010;3:491-500. [PMID: 20647583] doi:10.1161/CIRCIMAGING.109.855981 CrossrefMedlineGoogle Scholar7. Tromeur C, van der Pol LM, Le Roux PY, Ende-Verhaar Y, Salaun PY, Leroyer C, et al. Computed tomography pulmonary angiography versus ventilation-perfusion lung scan for pulmonary embolism diagnosis during pregnancy: a systematic review and meta-analysis. Haematologica. 2018. [PMID: 30115658] doi:10.3324/haematol.2018.196121 CrossrefMedlineGoogle Scholar8. Ridge CA, Mhuircheartaigh JN, Dodd JD, Skehan SJ. Pulmonary CT angiography protocol adapted to the hemodynamic effects of pregnancy. AJR Am J Roentgenol. 2011;197:1058-63. [PMID: 22021496] doi:10.2214/AJR.10.5385 CrossrefMedlineGoogle Scholar9. Scarsbrook AF, Bradley KM, Gleeson FV. Perfusion scintigraphy: diagnostic utility in pregnant women with suspected pulmonary embolic disease. Eur Radiol. 2007;17:2554-60. [PMID: 17342484] CrossrefMedlineGoogle Scholar10. ACOG practice bulletin no. 196 summary: thromboembolism in pregnancy. Obstet Gynecol. 2018;132:243-8. [PMID: 29939933] doi:10.1097/AOG.0000000000002707 CrossrefMedlineGoogle Scholar Author, Article, and Disclosure InformationAffiliations: Brigham and Women's Hospital and Boston Children's Hospital, Boston, Massachusetts (A.M.V.)Brigham and Women's Hospital, Boston, Massachusetts (K.E.E.)Disclosures: Authors have disclosed no conflicts of interest. Forms can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M18-2818.Corresponding Author: Anne Marie Valente, MD, Department of Cardiology, Boston Children's Hospital, 300 Longwood Avenue, Boston, MA 02115; e-mail, anne.[email protected]chboston.org.Current Author Addresses: Dr. Valente: Department of Cardiology, Boston Children's Hospital, 300 Longwood Avenue, Boston, MA 02115.Dr. Economy: Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02130.This article was published at Annals.org on 23 October 2018. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetailsSee AlsoDiagnosis of Pulmonary Embolism During Pregnancy Marc Righini , Helia Robert-Ebadi , Antoine Elias , Olivier Sanchez , Emmanuelle Le Moigne , Jeannot Schmidt , Catherine Le Gall , Jacques Cornuz , Drahomir Aujesky , Pierre-Marie Roy , Céline Chauleur , Olivier T. Rutschmann , Pierre-Alexandre Poletti , Grégoire Le Gal , and Metrics Cited byPoint-of-care ultrasound in the assessment of community acquired pneumonia in pregnant womenEcografía clínica en la valoración de neumonía adquirida en la comunidad en gestantesTrends in Medical Imaging During Pregnancy in the United States and Ontario, Canada, 1996 to 2016 4 December 2018Volume 169, Issue 11Page: 810-811KeywordsAlgorithmsD-dimerLungsObstetrics and gynecologyPregnancyPulmonary embolismRadiation exposureSafetySigns and symptomsVentilation perfusion ePublished: 23 October 2018 Issue Published: 4 December 2018 Copyright & PermissionsCopyright © 2018 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...