Diagnosing Pulmonary Embolism During Pregnancy

Area of Science:

• Obstetrics and Gynecology
• Cardiology
• Radiology

Background:

• Pulmonary embolism (PE) is a significant cause of maternal mortality in high-income countries.
• Delayed diagnosis of PE in pregnancy is often due to overlapping symptoms with physiological changes.
• Prompt diagnosis and management of PE are critical for improving maternal outcomes.

Purpose of the Study:

• To provide a contemporary overview of diagnostic strategies for pulmonary embolism in pregnancy.
• To review risk assessment tools, diagnostic modalities, and counseling needs for pregnant patients with suspected PE.
• To summarize current best practice guidance for the diagnosis of PE during pregnancy.

Main Methods:

• This narrative review synthesizes current literature on PE diagnosis in pregnancy.
• It examines risk stratification tools, including the revised Geneva score and YEARS algorithm.
• It evaluates the safety and efficacy of diagnostic imaging modalities such as CT pulmonary angiography and V/Q scans.

Main Results:

• Risk stratification tools like the revised Geneva score and YEARS algorithm are effective for diagnosing PE in pregnancy.
• CT pulmonary angiography and ventilation-perfusion scans demonstrate comparable safety and effectiveness.
• Iodinated contrast agents used in CTPA pose no risk to neonates, and counseling is vital for managing patient anxiety.

Conclusions:

• Diagnostic testing for PE in pregnancy should consider equipment availability, timeliness, clinical urgency, and chest radiography findings.
• Clinical prediction rules are increasingly supported by recent guidelines.
• Both CTPA and V/Q scans are safe, with test selection influenced by initial radiography and suspicion of other conditions.