Thromboembolism in Pregnancy

Rosenberg, Victor; Lockwood, Charles J.

doi:10.1016/j.ogc.2007.06.006

Cited by 41 publications

(64 citation statements)

References 103 publications

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“…1,2,21,22 In the United States it is responsible for 19.6% of pregnancy-related deaths. 23 In Japan, PE causes more deaths in the 20 to 39 year age group than any other age and there was a 6.5 fold increase in reported cases of PE in obstetrics and gynaecology from 1991 to 2000. 24 …”

Section: Managementmentioning

confidence: 99%

“…23,26,28,30 Some reports found the combination of dyspnoea, tachypnoea, pleuritic chest pain and syncope or near syncope in 90% of cases 23,28 while other data showed that 60 to 80% of patients who died had no clinical signs or symptoms. 27 …”

Section: Clinical Presentationmentioning

confidence: 99%

“…Arterial blood gasses: most patients with PE will have a low PaO 2 and raised PaCO 2 , but in up to 20% of women with PE this can be normal. 23,25,27,29,30 The chest X-ray findings include: atelectasis, infiltrates, effusion, regional oligaemia and pulmonary oedema. 23,27,31,32 The classical wedge shape infiltrate or decreased vascularity is seldom seen.…”

Section: Diagnosismentioning

confidence: 99%

“…25,27,30,32,33 The classical signs on ECG of a deep S wave in lead I, inverted T and Q waves in lead III and signs of right heart strain are infrequent 25,27,32 and not of value in the diagnosis if there is reasonable clinical suspicion of PE. 23,30,31 D-dimer testing has been used in the screening of patients with suspected pulmonary embolism. 23,25,[30][31][32] D-dimer testing is dependent on the type of testing method that is used and unfortunately different methods have different values and sensitivities.…”

Section: Diagnosismentioning

confidence: 99%

“…23,30,31 D-dimer testing has been used in the screening of patients with suspected pulmonary embolism. 23,25,[30][31][32] D-dimer testing is dependent on the type of testing method that is used and unfortunately different methods have different values and sensitivities. 23,25 There is some controversy regarding the use after a case report described a patient with a normal D-dimers and pulmonary embolism.…”

Section: Diagnosismentioning

confidence: 99%

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Managing acute collapse in pregnant women

Lombaard

Soma-Pillay

Farrell

2009

Best Practice & Research Clinical Obstetrics & Gynaecol

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Keywords:acute collapse pulmonary embolism amniotic fluid embolism acute coronary syndrome mechanical prosthetic heart valves acute aortic dissection cerebrovascular incidents and anaesthetic complications failed intubation anaphylaxisThe most important causes of acute collapse in pregnancy are pulmonary embolism, amniotic fluid embolism, acute coronary syndrome, thrombosed mechanical prosthetic heart valves, acute aortic dissection, cerebrovascular incidents and anaesthetic complications like failed intubation, anaphylaxis, and problems relating to regional or local anaesthetic agents. The management is based on supporting the different organ systems that are affected. The diagnosis of pulmonary embolism is based on a clinical suspicion supported by certain diagnostic test. Tests like D-dimers have their limitations and cannot be used alone to exclude the diagnosis especially when there is a high clinical suspicion. The choice of the best diagnostic tool is based upon weighing longterm risks to both mother and foetus on the one side and delaying the diagnosis on the other side. The management of acute coronary syndrome is based on immediate angiography and percutaneous coronary intervention. Although there are reports of the use of clopidrogel in pregnancy, there are few data on its effect on the foetus. There is no clinical evidence for fibrinolytic therapy as a reperfusion strategy in pregnancy and it is best avoided as the risk of haemorrhage outweighs the possible benefit of treatment. Patients with a prosthetic heart valve that present with a disappearance of the prosthetic heart sounds or a new murmur should get an urgent cardiac ultrasound to rule out a thrombosed prosthetic valve. Anaesthesia-related causes are an increasing cause of maternal morbidity and mortality.

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Section: Managementmentioning

confidence: 99%

Section: Clinical Presentationmentioning

confidence: 99%

Section: Diagnosismentioning

confidence: 99%

Section: Diagnosismentioning

confidence: 99%

Section: Diagnosismentioning

confidence: 99%

See 3 more Smart Citations

Managing acute collapse in pregnant women

Lombaard

Soma-Pillay

Farrell

2009

Best Practice & Research Clinical Obstetrics & Gynaecol

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Imaging for the exclusion of pulmonary embolism in pregnancy

Jong

Mens

Leeflang

et al. 2014

Cochrane Database of Systematic Reviews

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Imaging for the exclusion of pulmonary embolism in pregnancy

Mens

Scheres

Jong

et al. 2017

Cochrane Database of Systematic Reviews

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Both CTPA and lung scintigraphy seem appropriate for exclusion of pulmonary embolism during pregnancy. However, the quality of the evidence mandates cautious adoption of this conclusion. Important limitations included poor reference standards, necessary assumptions in the analysis regarding inconclusive test results and the inherent inability of included studies to identify false positives. It is unclear which test has the highest accuracy. There is a need for direct comparisons between diagnostic methods, including MR, in prospective randomized diagnostic studies.

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Thromboembolism in Pregnancy

Cited by 41 publications

References 103 publications

Managing acute collapse in pregnant women

Managing acute collapse in pregnant women

Imaging for the exclusion of pulmonary embolism in pregnancy

Imaging for the exclusion of pulmonary embolism in pregnancy

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