Pulmonary Embolism (PE) in pregnancy
Questionnaire/history:
Chest pain?
- Pleuritic (53%)?
- Non-pleuritic (21%)?
Shortness of breath?
- At rest (54%)?
- On exertion (51%)?
Haemoptysis (7%)?
Cough (9%)?
Syncope (5%)?
Palpitations - 13%
Temperature >37.5 - 8%
Tachycardia (>100 in T1-2 or >110 T3) - 30%
Tachypnoea RR > 24 - 10%
SpO2 < 94% (15%)?
Key risk factors?
Obesity?
- BMI > 30 (4x VTE risk increase)
Age?
- > 45 years?
Long-haul travel?
Past medical history?
Current medication?
Known drug allergies?
Management:
Any pregnant (or postpartum) woman with suspected PE should be admitted to hospital for further investigations:
- Duplex scan of the deep veins (to look for DVT) and if no signs of DVT but PE is suspected further imaging with either CTPA or VQ scan
RCOG risk assessment for VTE
Score ≥ 4: consider thromboprophylaxis from 1st trimester
Score 3: consider thromboprophylaxis from 28 weeks
Resource(s):
RCOG VTE management 2015