Pulmonary embolism in pregnancy

Pulmonary embolism (PE) is very rarely observed during pregnancy and postpartum period. The frequency of PE in pregnant women is relatively difficult to assess because the existing data estimate all venous-thromboembolic (VTE) complications including deep venous thrombosis (DVT) and PE. The incidence of PE itself has been evaluated on 3 cases per 10000 deliveries. Diagnostics of PE during pregnancy is very difficult and requires unequivocal confirmation or exclusion because of exposure of fetus to potential complications of antithrombic therapy. Very important is to assess the clinical probability of PE with note of potential risk factors (including Well's score using), precision medical history and physical examination. Noninvasive examinations: ECG, echocardiography, venous compression USG and laboratory tests: arterial blood gas analysis and level of dimer D. According to the current ESC guidelines CT angiography should be considered if the chest X-ray is abnormal or if lung scintigraphy is not readily available (class IIa). Perfusion scintigraphy may be considered to rule out suspected PE in pregnant women with normal chest X-ray. (Class IIb). A weight-adjusted dose of LMWH is recommended therapy during pregnancy in patients without shock or hypotension. In high-risk patients thrombolytic therapy is justified. Anticoagulant treatment should be administered for at least 6 weeks after delivery and with a minimum overall treatment duration of 3 months.