PULMONARY EMBOLISM IN PREGNANCY

Abstract

Pulmonary embolism (PE) is one of the leading cause of maternal morbidity and mortality in developed countries. Venous stasis, vascular endothelial injury and hypercoagulation (Virchow triad) are all responsible for the increased risk of venous thromboembolism (VTE) in pregnancy. The most common additional risk factors of VTE in pregnancy are obesity, immobility, varicose veins and inflammatory bowel diseases. Clinical manifestation of PE during pregnancy is misleading because physiological changes result in the signs and symptoms quite similar to PE. Clinical suspicion of PE can be assessed by We l l s questionnaire, and according to its result, the further patient examination can be planed. Recent studies suggest that the PE diagnosis can be excluded using YEARS algorithm. This algorithm allows preventing the pregnant patient from unnecessary radiological testing. PE treatment is a difficult task to find a balance between effectiveness of the maternal treatment, safety, fetal well being and an increased risk of haemorrhage. Unfractionated heparin and lowmolecular weight heparins are safe and effective for PE treatment in obstetrics. However, the individual risk assessment of VTE and appropriate thromboprophylaxis are essential in order to reduce PE related maternal morbidity and mortality.