Pulmonary embolism in pregnancy: Epidemiology, pathogenesis, and diagnosis
- David R Schwartz, MD
David R Schwartz, MD
- Associate Professor of Clinical Medicine
- Section Chief, Critical Care
- NYU Medical Center
- Atul Malhotra, MD
Atul Malhotra, MD
- Kenneth M Moser Professor, Department of Medicine
- University of California, San Diego
- Steven E Weinberger, MD
Steven E Weinberger, MD
- Adjunct Professor of Medicine
- University of Pennsylvania School of Medicine
- Executive Vice President and CEO
- American College of Physicians
- Section Editors
- Lawrence LK Leung, MD
Lawrence LK Leung, MD
- Editor-in-Chief — Hematology
- Section Editor — Disorders of Hemostasis and Coagulation
- Professor of Medicine
- Stanford University School of Medicine
- Jess Mandel, MD
Jess Mandel, MD
- Section Editor — Pulmonary Vascular Disease
- Professor of Medicine
- University of California, San Diego
- Charles J Lockwood, MD, MHCM
Charles J Lockwood, MD, MHCM
- Section Editor — Obstetrics
- Senior Vice President, USF Health
- Dean, Morsani College of Medicine
- Professor, Obstetrics and Gynecology
- University of South Florida
Pregnancy and the puerperium (postpartum period) are well-established risk factors for venous thromboembolism (VTE), with VTE occurring in approximately 1 in 1600 pregnancies [1-3].
VTE can manifest during pregnancy as an isolated lower extremity deep venous thrombosis (DVT) or clot can break off from the lower extremities and travel to the lung to present as pulmonary embolus (PE). In the United States, PE is the sixth leading cause of maternal mortality, responsible for 20 to 30 percent of maternal deaths [4-7]. Preventing deaths from PE in pregnancy requires a high index of clinical suspicion focused on an accurate diagnostic approach so that appropriate treatment with anticoagulation can be initiated in a timely fashion.
The diagnosis of PE during pregnancy will be reviewed here. The epidemiology and pathogenesis of VTE, the diagnosis of DVT during pregnancy, and the prevention and treatment of DVT and PE during pregnancy are discussed separately. (See "Deep vein thrombosis in pregnancy: Epidemiology, pathogenesis, and diagnosis" and "Deep vein thrombosis and pulmonary embolism in pregnancy: Prevention" and "Deep vein thrombosis and pulmonary embolism in pregnancy: Treatment".)
The epidemiology of VTE during pregnancy and the puerperium is discussed separately. (See "Deep vein thrombosis in pregnancy: Epidemiology, pathogenesis, and diagnosis", section on 'Epidemiology'.)
Factors that increase the risk of VTE during pregnancy and the puerperium are discussed separately. (See "Deep vein thrombosis in pregnancy: Epidemiology, pathogenesis, and diagnosis", section on 'Compressive ultrasound and subsequent testing'.)
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- RISK FACTORS
- CLINICAL PRESENTATION
- LABORATORY STUDIES
- Chest radiograph
- V/Q scan
- CT pulmonary angiography
- Magnetic resonance pulmonary angiography
- Contrast-enhanced pulmonary artery angiography
- DIAGNOSTIC ALGORITHM
- Pretest probability
- - Initial CUS
- - Chest radiograph
- - Selection of imaging modality
- Comparison of V/Q and CTPA
- Radiation and contrast exposure
- - Radiation
- - Contrast
- Practical considerations
- DIAGNOSIS OF PE
- DIFFERENTIAL DIAGNOSIS OF PE
- INFORMATION FOR PATIENTS
- SUMMARY AND RECOMMENDATIONS