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Diagnosing Pulmonary Embolism in Pregnancy: Synthesis of Current Guidelines and New Evidence

Published:April 28, 2020DOI:https://doi.org/10.1016/j.jogc.2020.03.025

      Abstract

      Pulmonary embolism (PE) complicates 5.4 per 10 000 pregnancies and remains a significant cause of maternal mortality. Prompt diagnosis and treatment of PE are key to ensuring optimal outcomes, but are not without risks associated with over-testing. Given the paucity of evidence informing PE diagnosis in pregnancy, marked heterogeneity exists among different societies in their recommendations.
      Here we provide an overview of existing recommendations and novel evidence informing the diagnosis of PE in pregnancy, including the use of d-dimers, the choice of diagnostic imaging modality, and the potential for breast cancer risk among women exposed to ionizing radiation from computed tomography pulmonary angiography (CTPA).

      Résumé

      L'embolie pulmonaire (EP) complique 5,4 par 10 000 grossesses et demeure une cause importante de mortalité maternelle. Le diagnostic et le traitement rapides de l'EP sont essentiels pour favoriser les issues optimales, mais pas sans le risque de procéder à des analyses trop nombreuses en raison du manque d'algorithmes de prédiction du risque normalisés dans le cadre obstétrical. Compte tenu de la rareté des données probantes disponibles pour étayer le diagnostic d'EP pendant la grossesse, il existe une hétérogénéité marquée entre les recommandations émises par les différentes sociétés.
      Nous donnons ici un aperçu des recommandations actuelles et des nouvelles données probantes sur le diagnostic de l'EP pendant la grossesse, notamment l'utilisation des d-dimères, le choix de la modalité d'imagerie diagnostique et le risque potentiel de cancer du sein chez les femmes exposées aux rayonnements ionisants de l'angiographie pulmonaire par tomodensitométrie.

      Keywords

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