Pulmonary embolism in pregnancy

Background

  • Also consider V/Q in young females in order to minimize radiation exposure to breast tissue
  • Also consider V/Q vs CTPA in pregnant females depending on multiple considerations including the above + radiation burden to fetus

Clinical Features

See Pulmonary Embolism

Differential Diagnosis

Workup

  1. Clinical features suggestive of PE
    1. Bilateral LE Ultrasound
      1. Positive-->treat empirically for PE
      2. Negative-->CTA
        1. CT (with shield) vs. V/Q is roughly equilivalent radiation exposure

D-Dimer

  • D-Dimer MAY BE used with following limits with very poor evidence[1][2]
    • 1st trimester: <750 ng/mL (+50% increase from normal lab threshold)
    • 2nd trimester: <1000 ng/mL (+100% from normal)
    • 3rd trimester: <1250 ng/mL (+150% from normal)

Management

Disposition

Admit

See Also

Sources

  1. ↑ Kovac M. The use of D-dimer with new cutoff can be useful in diagnosis of venous thromboembolism in pregnancy. Eur J Obstet Gynecol Reprod Biol. 2010 Jan;148(1):27-30
  2. ↑ http://blog.ercast.org/2013/04/pulmonary-embolism-in-pregnancy/
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