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[Pulmonary embolism and pregnancy].

¹Service de Pneumologie et de Maladies Vasculaires Pulmonaires, Hôpital Antoine-Béclère, Université Paris-Sud, Clamart.

Revue Des Maladies Respiratoires

|July 25, 2000

Summary

Pulmonary embolism (PE) is a significant cause of maternal mortality, with increased risks during pregnancy and postpartum due to physiological changes. Diagnosis and treatment involve non-invasive methods and heparin, avoiding coumarin due to fetal risks.

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Area of Science:

Obstetrics and Gynecology
Cardiology
Hematology

Background:

Pulmonary embolism (PE) is a leading cause of maternal mortality during pregnancy and the postpartum period.
The risk of venous thromboembolism (VTE) in pregnancy ranges from 1:1000 to 1:2000 pregnancies, influenced by physiological and biological changes in coagulation and fibrinolysis.
Risk factors for VTE in pregnancy include advanced maternal age (>35), history of VTE, thrombophilia, and cesarean delivery.

Observation:

Diagnostic strategies for PE in pregnant patients should prioritize non-invasive methods, such as lower limb ultrasonography and pulmonary scintigraphy.
No diagnostic examination is contraindicated in pregnant individuals, but a non-invasive approach is preferred.
Diagnosis must be confirmed with the same rigor as in non-pregnant patients.

Findings:

Heparin is the primary treatment for PE during pregnancy, while coumarin is contraindicated due to teratogenic risks.
Low molecular weight heparin (LMWH) is not routinely used but emerging data suggest potential safety and efficacy comparable to unfractionated heparin.
Indications for anticoagulant prophylaxis in pregnancy remain inadequately defined.

Implications:

Accurate and timely diagnosis of PE in pregnant patients is crucial for reducing maternal mortality.
Non-invasive diagnostic modalities are essential for evaluating suspected PE in pregnancy.
Current treatment guidelines favor heparin, with ongoing research into the role of LMWH in pregnant populations.
Further research is needed to clarify indications for anticoagulant prophylaxis during pregnancy to optimize VTE prevention.

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