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Alveolar-arterial oxygen gradient in acute pulmonary embolism in pregnancy
R O Powrie1, L Larson, K Rosene-Montella
1Department of Medicine, Women and Infants Hospital of Rhode Island and Brown University School of Medicine, Providence 02905-2401, USA.
Objective:
Our goal was to determine the prevalence of normal alveolar-arterial gradients in pregnant patients with documented pulmonary embolism.
Study Design:
A retrospective chart review was performed on all pregnant women with pulmonary embolism at two large obstetric centers between 1990 and 1995. Alveolar-arterial gradients were calculated from room air arterial blood gas values and compared with values from patients who had been established as normal.
Results:
Ten of 17 patients with pulmonary embolism identified had alveolar-arterial gradients that were normal.
Conclusions:
In our study 58% of pregnant women with documented pulmonary embolism had a normal alveolar-arterial gradient. This markedly differs from the published data in nonpregnant patients, in which the incidence of normal alveolar-arterial gradients in pulmonary embolism has ranged from 1.9% to 20%. This suggests that the alveolar-arterial gradient should not be used to determine the likelihood of pulmonary embolism in pregnant women because this could lead to the withholding of appropriate treatment for this life-threatening condition.