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Published on: February 10, 2023
Venous Thromboembolism Management in Pregnant Patients
Linzi A Webster1, Vivian Bishay1
1Division of Vascular and Interventional Radiology, Department of Diagnostic, Molecular & Interventional Radiology, Mount Sinai Health System, New York, NY.
Insights
Pulmonary embolism (PE) in pregnancy is a leading cause of maternal death. This review highlights key differences in diagnosing and managing PE in pregnant versus non-pregnant patients, focusing on advanced therapies.
Area of Science:
- Cardiology
- Obstetrics
- Pulmonology
Background:
- Pulmonary embolism (PE) in pregnancy contributes significantly to maternal mortality in the US.
- Increasing maternal morbidity and mortality necessitate updated understanding of PE management in pregnant patients.
- High-risk pregnancy-associated PE (PA-PE) presents unique challenges compared to non-pregnant PE.
Conclusions:
- Understanding the nuances of PA-PE diagnosis and management is crucial for obstetric and medical teams.
- Catheter-based therapies offer promising treatment avenues for complex PA-PE cases.
- Further research into optimal management strategies for PA-PE is warranted.
Abstract:
Pulmonary embolism (PE) in pregnancy accounts for 10% of maternal deaths in the United States. As maternal morbidity and mortality continue to increase, it is imperative for all specialties interfacing with pregnant patients to understand the current research and guidelines surrounding risk stratification, diagnosis, and treatments of PE in pregnancy. Given the complexity of high-risk pregnancy-associated PE (PA-PE), that is, which is associated with hemodynamic instability or collapse, and the rising popularity of new technologies to treat high-risk PA-PE in the nonpregnant population, this review aims to emphasize the differences in diagnosis, risk stratification, and management of the pregnant and nonpregnant PE patients. Furthermore, this review will cover treatment paradigms that include anticoagulation versus advanced therapies such as systemic thrombolysis, surgical embolectomy, extracorporeal membrane oxygenation, and inferior vena cava disruption as well as the more novel therapies which fall under the umbrella term of catheter-based treatments. Finally, this review will include a case-based review of 2 patients with PA-PE requiring catheter-based therapies and their ultimate clinical outcomes.
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