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Semin Respir Crit Care Med 2021; 42(02): 284-298
DOI: 10.1055/s-0041-1722867
Review Article

Pulmonary Embolism in Pregnancy

Shannon M. Bates   *
1   Department of Medicine, McMaster University, Hamilton, Ontario, Canada
2   Thrombosis and Atherosclerosis Research Institute, Hamilton, Ontario, Canada
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Abstract

Even though venous thromboembolism is a leading cause of maternal mortality in high-income countries, there are limited high-quality data to assist clinicians with the management of pulmonary embolism in this patient population. Diagnosis, prevention, and treatment of pregnancy-associated pulmonary embolism are complicated by the need to consider fetal, as well as maternal, well-being. Recent studies suggest that clinical prediction rules and D-dimer testing can reduce the need for diagnostic imaging in a subset of patients. Low-molecular-weight heparin is the preferred anticoagulant for both prophylaxis and treatment in this setting. Direct oral anticoagulants are contraindicated during pregnancy and in breastfeeding women. Thrombolysis or embolectomy should be considered for pregnant women with pulmonary embolism complicated by hemodynamic instability. Treatment of pregnancy-associated pulmonary embolism should be continued for at least 3 months, including 6 weeks postpartum. Management of anticoagulants at the time of delivery should involve a multidisciplinary individualized approach that uses shared decision making to take patient and caregiver values and preferences into account.

Keywords

pregnancy - postpartum - pulmonary embolism - diagnosis - low-molecular-weight heparin - anticoagulants - thrombophilia

* Eli Lilly Canada May Cohen Chair in Women's Health




Publication History

Article published online:
06 February 2021

© 2021. Thieme. All rights reserved.

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