Deep Vein Thrombosis & Pulmonary Embolism in Pregnancy: Controversies continue
Nice to see the people at the NEJM continue to provide us with clinically relevant topics across all specialities: none more so than the complication of DVT in pregnant women.The review article (link here) highlights management and thromboprophylaxis in the NEJM. What is more interesting to my eyes is the actual planned investigation of suspected PE in patients who do not have a clinically proven DVT.
An interesting viewpoint for our British Readers can be found at the BTS guidelines in the management of pulmonary embolism here. Note how the issue of imaging in pregnancy is not exactly clear cut!
Nevertheless despite the use of a Well’s score, and ultrasound dopplers of the lower limbs, the jury is still out on the imaging modality of choice for pregnant women with suspected pulmonary embolism (i.e. CT Pulmonary Angiography (CTPA) , Limited CTPA, Limited Nuclear Medicine Scanning, MRI). The risks from nuclear medicine imaging seem likely to be higher than CT given the added problems of a reduced sensitivity and specificity, whereas the use of MRI is limited in the UK by the relative paucity of units offering this as a service/ lack of scanning facilities in some smaller hospitals.
Even though a lead apron will protect the foetus there are still concerns from CT about maternal breast tissue in this situation.
In the absence of hard and fast rules, this is an area of medicine that continues to challenge clinicans on a dya to day basis.