Diagnosis of deep vein thrombosis and pulmonary embolism in pregnancy
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Venous thromboembolism (VTE) is a major cause of maternal morbidity and mortality. Because unrecognized and untreated pulmonary embolism (PE) can result in maternal mortality, physician vigilance for this disease should remain high. The diagnosis of both PE and deep vein thrombosis (DVT) in the pregnant patient, as in the nonpregnant patient, requires the use of accurate objective imaging. However, unlike the nonpregnant population, there is a paucity of trials evaluating the safety and accuracy of objective testing for PE or DVT diagnosis in pregnant patients--likely because of concerns surrounding the use of ionizing radiation associated with diagnostic tests during pregnancy. Regardless of extrapolating results from studies in the nonpregnant population, the use of compression leg ultrasound and ventilation-perfusion (VQ) scanning during pregnancy is central to the diagnosis of DVT and PE, respectively. Data on the utility of structured clinical models or D-dimer testing for the diagnosis of DVT or PE during pregnancy is currently unavailable. Future research is urgently needed to validate the use of current approaches and perhaps define safer and more accurate strategies to reduce maternal morbidity from this disease.
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