Suspected Pulmonary Embolism in Pregnancy

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Abstract
PULMONARY EMBOLISM (PE) is a major preventable cause of maternal mortality during pregnancy and the puerperium.1-3 As in nonpregnant patients, the diagnosis of PE during pregnancy is usually made by combining clinical probability and the results of objective testing.4,5 Ventilation-perfusion (VQ) scanning remains a widely used imaging technique for the investigation of PE in nonpregnant patients.4,5 Results from PE diagnostic studies have been extrapolated to pregnant women even though these patients have been systematically excluded from participation in these studies largely due to concerns (on behalf of physicians and patients) about the dangers of fetal radiation exposure. The assumption that the results of lung scans in nonpregnant patients are generalizable to the pregnant subject might be incorrect because, as a group, pregnant women are younger and less likely to have concomitant respiratory illnesses that could cause an abnormal scan, but they might have physiological changes such as compression of the lungs by the enlarging uterus that could cause an abnormal scan. These issues are further confounded by nonthrombotic symptoms that mimic PE, such as shortness of breath and chest pain, which are common during pregnancy.