Pulmonary Embolism During Pregnancy

Diagnostic approach to pulmonary embolism in pregnancy: are the winds of change upon us or is it déjà vu all over again?

“…The recognition in the 1960s that a PE can be encountered in any trimester of pregnancy and that the puerperium remains a time of heightened susceptibility to its development, saw the emergence of admonitions for treatment of any perinatally encountered leg or chest pain as a potential venous thromboembolism (VTE) until proven otherwise, with recommendations for urgent commencement of anticoagulation pending confirmation or exclusion of the diagnosis (Henderson et al, 1972). Radioactive isotope lung scans and pulmonary angiography were proposed as imaging modalities of choice in this endeavour, acknowledging that fetal radiation hazards lacked precise estimates of harm (Evans et al, 1968).…”

“…Reports dating as far back as the 1960s have acknowledged the similarities between the manifestations of a PE (including dyspnoea, palpitations, chest pain and anxiety) and symptoms frequently experienced in normal pregnancies (Evans et al, 1968), a feature continuing to stymy consultants' attempts aimed at accurately allocating individual pre-test probabilities of a PE prior to committing to a full set of investigations (Chan, 2017;Wan et al, 2017). This overlap of physiological symptoms with those of a potentially fatal condition has also thwarted attempts at use of clinical prediction rules, such as the Wells Score, which are routinely utilized in the non-pregnant population, but which have not been validated in pregnancy (van Loon & Stekkinger, 2007;Wan et al, 2017).…”