Pulmonary embolism during pregnancy: a novel diagnostic stra
A strategy that combines the assessment of clinical probability, D-dimer measurement, compression ultrasonography and CT pulmonary angiography safely and effectively diagnoses pulmonary embolism in pregnant women, according to findings published in Annals of Internal Medicine.

The researchers conducted a multinational study to evaluate a diagnostic algorithm for PE in pregnant women. The researchers enrolled 395 pregnant women with clinically suspected PE in EDs.

All participants underwent pretest clinical probability assessment and high-sensitivity D-dimer testing. If those test results excluded PE, participants also underwent bilateral lower limb compression ultrasonography, then CT pulmonary angiography if necessary. If all assessments were negative, participants received a ventilation-perfusion scan.

During the 3-month follow-up, the researchers measured the rate of adjudicated venous thromboembolic events.

Overall, 7.1% of participants (28) were diagnosed with PE. Proximal deep venous thrombosis was identified via ultrasound in seven women, CT pulmonary angiography in 19 women and ventilation–perfusion scan in two women.

PE was ruled out in 46 women because of low or intermediate pretest clinical probability and negative D-dimer results, 290 women because of a negative CT pulmonary angiography, 17 women because of normal or low ventilation-perfusion scan results and 14 women for other reasons.

Of the women without a PE diagnosis, 22 received extended anticoagulation, mostly for previous venous thromboembolic disease, during follow-up. At 3 months, there was a 0% rate of symptomatic venous thromboembolic events among participants who did not receive treatment based on negative results on the diagnostic strategy.

"A diagnostic strategy based on assessment of clinical probability, D-dimer measurement, CUS, and CTPA can safely rule out PE in pregnant women." the authors have concluded.

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