Can pregnancy-adapted algorithms avoid diagnostic imaging for pulmonary embolism?

Area of Science:

• Obstetrics and Gynecology
• Pulmonology
• Radiology

Background:

• Pulmonary embolism (PE) is rare in pregnant patients with suspected disease.
• Diagnostic imaging like CT pulmonary angiography and V/Q scans are typically used.
• Low prevalence necessitates accurate diagnostic strategies to avoid unnecessary procedures.

Observation:

• Clinical prediction rules (YEARS, revised Geneva) combined with D-dimer testing show potential for excluding PE.
• The YEARS criteria safely excluded up to one-third of pregnant patients without imaging.
• The revised Geneva rule excluded fewer patients (14%) but used objective variables.

Findings:

• Current prediction rules and D-dimer tests can help avoid imaging in a subset of pregnant patients.
• Imaging remains the primary diagnostic option for most pregnant individuals with suspected PE.
• Further research is needed to improve D-dimer specificity and objective prediction rules.

Implications:

• Radiation avoidance is possible for some pregnant patients, reducing potential risks.
• Future studies should focus on enhancing imaging safety and diagnostic test accuracy.
• Shared decision-making incorporating patient/physician values is crucial for managing suspected PE in pregnancy.