PURL: Ruling out PE in pregnancy.

Area of Science:

• Obstetrics and Gynecology
• Cardiology
• Diagnostic Medicine

Background:

• Pulmonary embolism (PE) is a significant cause of maternal morbidity and mortality.
• Diagnostic uncertainty often arises due to overlapping symptoms with common pregnancy-related conditions.
• Accurate and safe diagnostic strategies are crucial for pregnant patients.

Purpose of the Study:

• To evaluate the safety and reliability of using clinical probability combined with a high-sensitivity D-dimer assay to rule out pulmonary embolism in pregnant women.
• To determine if this diagnostic pathway can avoid unnecessary imaging procedures.

Main Methods:

• Prospective cohort study design.
• Inclusion of pregnant patients presenting with suspected pulmonary embolism.
• Assessment of pre-test clinical probability using a validated scoring system.
• Performance of high-sensitivity D-dimer testing.
• Follow-up to ascertain diagnostic outcomes and adverse events.

Main Results:

• The combination of clinical probability and high-sensitivity D-dimer testing demonstrated a high negative predictive value.
• A negative result reliably excluded pulmonary embolism in the studied cohort.
• No major adverse events related to the diagnostic strategy were reported.

Conclusions:

• Clinical probability assessment coupled with high-sensitivity D-dimer testing offers a safe and effective strategy for ruling out pulmonary embolism in pregnancy.
• This approach can potentially reduce the need for radiation-exposed diagnostic imaging in pregnant patients.