By Dr Deepu
Background:
Pulmonary embolism (PE) is a leading cause of maternal mortality in the
developed world. Along with appropriate prophylaxis and therapy, prevention of
death from PE in pregnancy requires a high index of clinical suspicion followed
by a timely and accurate diagnostic approach.
Methods: To provide guidance on this important
health issue, a multidisciplinary panel of major medical stakeholders was
convened to develop evidence-based guidelines for evaluation of suspected
pulmonary embolism in pregnancy using the Grades of Recommendation, Assessment,
Development, and Evaluation (GRADE) system. In formulation of the recommended
diagnostic algorithm, the important outcomes were defined to be diagnostic
accuracy and diagnostic yield; the panel placed a high value
onminimizingcumulative radiationdose when determining the recommended sequence
of tests.
Results: Overall,
the quality of the underlying evidence for all recommendations was rated as
very low or low, with some of the evidence considered for recommendations
extrapolated from studies of the general population. Despite the low-quality
evidence, strong recommendations were made for three specific scenarios: performance
of chest radiography (CXR) as the first radiation-associated procedure; use of
lung scintigraphy as the preferred test in the setting of a normal CXR; and
performance of computed-tomographic pulmonary angiography (CTPA) rather than
digital subtraction angiography (DSA) in a pregnant woman with a nondiagnostic
ventilation– perfusion (V/Q) result.
Discussion: The
recommendations presented in this guideline are based upon the currently
available evidence; availability of new clinical research data and development
and dissemination of new technologies will necessitate a revision and update.
Download the Guideline Here: Pregnancy PE