Teaching Points
- The risks of inappropriate use of anticoagulation or missing the diagnosis of PE in pregnancy far outweigh the risks of exposing the mother and fetus to ionising radiation.
- A chest X-Ray is useful to exclude diagnoses that mimic PE and to further triage patients to the most appropriate investigation
- The D-Dimer test is less useful in pregnancy. However, in women with a low probability of PE and a negative D-Dimer, the diagnosis is excluded.
- Doppler US of both lower limbs has the benefit of being a radiation-free imaging modality. As venous thromboembolism is a continuous disease, the presence of DVT can be used as a surrogate marker of PE and treatment commenced if present.
- The evidence to recommend either CTPA or nuclear scintigraphy is complex. There are numerous issues to consider including effects to the mother and fetus. There is variation between scanning protocols between institutions and a decision as to the most appropriate test is best made after direct consultation with relevant specialists.
- MRI for the diagnosis of PE in pregnancy is a relatively new option with the distinct advantage of being a radiation-free modality. There is now promising emerging evidence supporting its use. However, availability and expertise remain the main limitations.
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