Risk is more increased if:
- >35 yrs
- higher parity
- raised BMI
- sickle cell
- not blood group O
The consensus on management of ?PE in pregnancy seems to be:
- CXR in all cases
- compression doppler in all cases - if this shows DVT you can just treat without needing to investigate further
In terms of the next investigation if you clinically suspect PE but the doppler is normal there is a lack of consensus:
- CTPA delivers 10-30% less radiation to the fetus but
- V/Q scan causes less radiation to the maternal breast tissue
In general CTPA seems to 'win'
Note that d-dimer is usually 'normal' in the first trimester of pregnancy, rises in the second to third and then returns to baseline at 4-6 weeks post-partum. However, it is generally not recommended as an investigation in pregnant women.
Treatment for DVT/PE in pregnancy is LMWH, continued for 6 months (with at least 6 weeks of anticoagulation post-partum)
For the really keen:
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