Diagnosing Pulmonary Embolism During Pregnancy

Diagnosing Pulmonary Embolism During Pregnancy

Authors: Hammache M, Simard C, Hamel S, Ouellet S, Jolicoeur G, Wou K, Sellen K, El-Jalbout R, Potts J, Bourjeily G, Koolian M, Tagalakis V, Skeith L, Le Gal G, Malhamé I

Journal: CHEST, 2025 (Narrative Review)

Conclusions:

  • Use structured clinical rules: The revised Geneva score and pregnancy-adapted YEARS are supported as safe, effective ways to risk-stratify pregnant patients with suspected PE.

  • Either imaging test is acceptable: CT pulmonary angiography (CTPA) and ventilation–perfusion (V/Q) scanning have comparable safety and effectiveness in pregnancy.

  • Contrast safety: Iodinated contrast for CTPA was not associated with neonatal adverse events in the evidence summarized.

  • Counseling matters: Pregnant patients often worry about fetal risk; clear counseling/shared decision-making improves care quality and acceptance of testing.

  • Guidelines align: Recent guidance endorses clinical prediction rules and considers both imaging modalities safe; some recommend choosing based on the chest radiograph.

  • Choose pragmatically: Select the pathway based on availability, speed, clinical urgency, CXR findings, and alternative diagnoses.

Results (Key Review Findings):

  • Risk tools: Revised Geneva and pregnancy-adapted YEARS are promising for safely supporting diagnosis/rule-out in pregnancy.

  • Imaging: CTPA vs V/Q—comparable diagnostic performance and safety; CXR-guided choice is reasonable per some guidelines.

  • Contrast: No signal of neonatal harm with iodinated contrast for CTPA in suspected PE.

  • Patient experience: Notable distress about fetal health during workup → prioritize anticipatory counseling and shared decision-making.

Methods:

  • Narrative review summarizing contemporary risk assessment tools, diagnostic modalities, counseling needs, and best-practice guidance for pregnancy-associated PE diagnosis.

  • Synthesizes recent guideline positions and practical considerations for test selection in real-world ED settings.

Hammache, M., Simard, C., Hamel, S., Ouellet, S., Jolicoeur, G., Wou, K., Sellen, K., El-Jalbout, R., Potts, J., Bourjeily, G. and Koolian, M., 2025. Diagnosing pulmonary embolism during pregnancy: A narrative review. Chest.

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