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Suspected Pulmonary Embolism in Pregnancy
Clinical Presentation, Results of Lung Scanning, and Subsequent Maternal and Pediatric Outcomes
W. S. Chan, MD, FRCPC;
J. G. Ray, MD, FRCPC;
S. Murray, MD, FRCPC;
G. E. Coady, MRT(N);
G. Coates, MD, FRCPC;
J. S. Ginsberg, MD, FRCPC
Arch Intern Med. 2002;162:1170-1175.
Background Ventilation-perfusion (VQ) scanning is used when pulmonary embolism
(PE) is suspected during pregnancy; however, the distribution of lung scan
results and safety of VQ scanning have never been studied.
Objective To study the distribution of lung scan results and safety of VQ scanning
as well as the safety of withholding anticoagulation therapy following a normal
or nondiagnostic scan in pregnant women.
Methods The study group comprised 120 consecutive pregnant women who presented
with suspected PE. Clinical data were collected, and the lung scans were reinterpreted
by 2 independent experts. Subsequent pregnancy and pediatric outcomes were
determined by direct patient follow-up.
Results During the study period, 120 pregnant women (mean age, 32 years) underwent
121 VQ scans. Eight cases (6.6%) were already receiving treatment for venous
thromboembolism prior to VQ scanning. In the remaining 113 scans, 83 (73.5%)
were interpreted as normal, 28 (24.8%) as nondiagnostic, and 2 (1.8%) as high
probability. In the 104 women who did not receive anticoagulation therapy
following lung scanning (80 normal and 24 nondiagnostic), no venous thromboembolic
events were reported (mean [range] length of follow-up, 20.6 [0.5-108] months).
Examination of pediatric data from 110 live births (90.2%) (mean [range] age,
20.5 [0.5-100] months) revealed no increase in the rates of congenital and
developmental anomalies.
Conclusions The prevalence of high-probability VQ scans in pregnant women with suspected
PE and probable PE is very low. Withholding anticoagulation in pregnant women
with normal or nondiagnostic VQ scans is probably safe. In addition, pediatric
risks from VQ scans are low. Large prospective studies are needed to evaluate
diagnostic strategies for pregnant women with suspected PE.
From the Departments of Medicine (Drs Chan and Ray) and Radiology (Dr
Murray and Mr Coady), Women's College Campus, Sunnybrook and Women's College
Health Sciences Centre, Toronto, Ontario; the Department of Clinical Epidemiology
and Biostatistics, McMaster University, Hamilton, Ontario (Dr Ray); and the
Departments of Nuclear Medicine (Dr Coates) and Medicine (Dr Ginsberg), Hamilton
Health Sciences, Hamilton, Ontario.
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