Pulmonary embolism in pregnancy

Background

• Also consider V/Q in young females in order to minimize radiation exposure to breast tissue
• Also consider V/Q vs CTPA in pregnant females depending on multiple considerations including the above + radiation burden to fetus

Workup

1. Clinical features suggestive of PE
   1. Bilateral LE Ultrasound
      1. Positive-->treat empirically for PE
      2. Negative-->CTA
         1. CT (with shield) vs. V/Q is roughly equilivalent radiation exposure

D-Dimer

• D-Dimer MAY BE (no RCTs) used with following limits:
  • 1st trimester: <750 (+50% increase from normal lab threshold)
  • 2nd trimester: <1000 (+100% from normal)
  • 3rd trimester: <1250 (+150% from normal)

Management

• Heparin and Enoxaparin are safe (coumadin is not)

Disposition

Admit

See Also

• Pulmonary Embolism