Diagnosis of Deep Vein Thrombosis and Pulmonary Embolism in Pregnancy and Postpartum: Should we Modify the Usual Diagnostic Strategy?
Summary In pregnant and postpartum patients, the incidence of venous thromboembolism (VTE) is increased three to fivefold compared with non‐pregnant women of the same age, and deep venous thrombosis (DVT) and pulmonary embolism (PE) are leading causes of maternal mortality during pregnancy and postp...
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| Published in | Imaging decisions MRI Vol. 11; no. 3; pp. 18 - 22 |
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| Main Authors | , |
| Format | Journal Article |
| Language | English |
| Published |
Oxford, UK
Blackwell Publishing Ltd
01.09.2007
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| Subjects | |
| Online Access | Get full text |
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| Abstract | Summary
In pregnant and postpartum patients, the incidence of venous thromboembolism (VTE) is increased three to fivefold compared with non‐pregnant women of the same age, and deep venous thrombosis (DVT) and pulmonary embolism (PE) are leading causes of maternal mortality during pregnancy and postpartum. Early and accurate diagnosis is essential as unnecessary anticoagulation is not without risk. However, the diagnosis of VTE among these women is complicated by difficulties in clinical diagnosis and the concerns regarding radiation exposure of the fetus. Many of the common diagnostic tests, including D‐dimer, compression ultrasonography, ventilation‐perfusion scintigraphy and helical computed tomography that have been extensively investigated in non‐pregnant patients, have not been appropriately validated in pregnancy. This article will review the role of various diagnostic tests in case of suspected VTE in pregnancy and puerperium, and issues such as radiation risk are discussed. Recommendations for the use of D‐dimer and imaging techniques in pregnant and postpartum patients with a clinically suspected DVT or PE are provided. |
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| AbstractList | Summary
In pregnant and postpartum patients, the incidence of venous thromboembolism (VTE) is increased three to fivefold compared with non‐pregnant women of the same age, and deep venous thrombosis (DVT) and pulmonary embolism (PE) are leading causes of maternal mortality during pregnancy and postpartum. Early and accurate diagnosis is essential as unnecessary anticoagulation is not without risk. However, the diagnosis of VTE among these women is complicated by difficulties in clinical diagnosis and the concerns regarding radiation exposure of the fetus. Many of the common diagnostic tests, including D‐dimer, compression ultrasonography, ventilation‐perfusion scintigraphy and helical computed tomography that have been extensively investigated in non‐pregnant patients, have not been appropriately validated in pregnancy. This article will review the role of various diagnostic tests in case of suspected VTE in pregnancy and puerperium, and issues such as radiation risk are discussed. Recommendations for the use of D‐dimer and imaging techniques in pregnant and postpartum patients with a clinically suspected DVT or PE are provided. |
| Author | Van Loon, A. J. Stekkinger, E. |
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| References_xml | – volume: 30 start-page: 1 year: 2000 end-page: 39 article-title: Publication 84. Pregnancy and medical radiation. publication-title: Ann ICRP – volume: 183 start-page: 91 year: 2004 end-page: 98 article-title: MR angiography with sensitivity encoding (SENSE) for suspected pulmonary embolism: comparison with MDCT and ventilation‐perfusion scintigraphy publication-title: AJR – volume: 2 start-page: 1857 year: 2004 end-page: 1858 article-title: Diagnosing pulmonary embolism in pregnancy: rationalizing fetal radiation exposure in radiological procedures publication-title: J Thromb Haemost – volume: 224 start-page: 487 year: 2002 end-page: 492 article-title: Pulmonary embolism in pregnant patients: fetal radiation dose with helical CT publication-title: Radiology – volume: 353 start-page: 1258 year: 1999 end-page: 1265 article-title: Thrombosis in pregnancy: maternal and fetal issues publication-title: Lancet – volume: 3 start-page: 268 year: 2005 end-page: 271 article-title: D‐dimer levels during delivery and the postpartum publication-title: J Thromb Haemost – volume: 184 start-page: 382 year: 2001 end-page: 389 article-title: Coagulation activation markers do not correlate with the clinical risk of thrombosis in pregant women publication-title: Am J Obstet Gynecol – volume: 335 start-page: 108 year: 1996 end-page: 114 article-title: Venous thromboembolism during pregnancy publication-title: N Engl J Med – volume: 15 start-page: 1234 year: 2005 end-page: 1240 article-title: The use of iodinated and gadolinium contrast media during pregnancy and lactation publication-title: Eur Radiol – volume: 115 start-page: 150 year: 2001 end-page: 152 article-title: TAFI antigen and D‐dimer levels during normal pregnancy and at delivery publication-title: Br J Haematol – volume: 162 start-page: 1170 year: 2002 end-page: 1175 article-title: Suspected pulmonary embolism in pregnancy publication-title: Arch Intern Med – volume: 359 start-page: 1643 year: 2002 end-page: 1647 article-title: Comparison of contrast‐enhanced magnetic resonance angiography and conventional pulmonary angiography for the diagnosis of pulmonary embolism: a prospective study publication-title: Lancet – volume: 94 start-page: 595 year: 1999 end-page: 599 article-title: Thrombotic risk during pregnancy: a population study publication-title: Obstet Gynecol – volume: 105 start-page: 257 year: 2002 end-page: 262 article-title: Plasma and serum levels of D‐dimer and their correlation with other hemostatic parameters in pregnancy publication-title: Thromb Res – volume: 100 year: 2002 article-title: Diagnosis of deep vein thrombosis during pregnancy: a pilot study evaluating the role of D‐dimer and compression leg ultrasound during pregnancy publication-title: Blood – volume: 143 start-page: 697 year: 2005 end-page: 706 article-title: Trends in the incidence of venous thromboembolism during pregnancy or postpartum: a 30‐year population‐based study publication-title: Ann Intern Med – ident: e_1_2_11_11_2 doi: 10.1111/j.1538-7836.2004.00929.x – ident: e_1_2_11_17_2 doi: 10.2214/ajr.183.1.1830091 – volume: 100 year: 2002 ident: e_1_2_11_10_2 article-title: Diagnosis of deep vein thrombosis during pregnancy: a pilot study evaluating the role of D‐dimer and compression leg ultrasound during pregnancy publication-title: Blood contributor: fullname: Chan WS – ident: e_1_2_11_13_2 doi: 10.1007/s00330-004-2583-y – ident: e_1_2_11_9_2 doi: 10.1016/S0049-3848(02)00022-1 – ident: e_1_2_11_6_2 doi: 10.1067/mob.2001.109397 – ident: e_1_2_11_8_2 doi: 10.1111/j.1538-7836.2004.01108.x – ident: e_1_2_11_3_2 doi: 10.1016/S0029-7844(99)00308-7 – ident: e_1_2_11_12_2 doi: 10.1016/S0146-6453(00)00024-5 – ident: e_1_2_11_15_2 doi: 10.1148/radiol.2242011581 – ident: e_1_2_11_14_2 doi: 10.1001/archinte.162.10.1170 – ident: e_1_2_11_7_2 doi: 10.1046/j.1365-2141.2001.03082.x – ident: e_1_2_11_5_2 doi: 10.1016/S0140-6736(98)10265-9 – ident: e_1_2_11_16_2 doi: 10.1016/S0140-6736(02)08596-3 – ident: e_1_2_11_2_2 doi: 10.1056/NEJM199607113350207 – ident: e_1_2_11_4_2 doi: 10.7326/0003-4819-143-10-200511150-00006 |
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In pregnant and postpartum patients, the incidence of venous thromboembolism (VTE) is increased three to fivefold compared with non‐pregnant women of... |
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| SubjectTerms | D-dimer deep vein thrombosis diagnosis fetal radiation exposure imaging techniques Pregnancy pulmonary embolism |
| Title | Diagnosis of Deep Vein Thrombosis and Pulmonary Embolism in Pregnancy and Postpartum: Should we Modify the Usual Diagnostic Strategy? |
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