EVALUATION OF PATIENTS WITH SUSPECTED VENOUS THROMBOEMBOLISM DURING PREGNANCY AND PUERPERIUM: FINDINGS OF DIAGNOSTIC STUDIES

Abstract

PURPOSE: A review of the diagnostic studies performed in the evaluation of suspected venous thromboembolism (VTE) in obstretical patients at a tertiary care center.
METHODS: A retrospective review of all obstetrical patients undergoing either ventilation-perfusion (VQ) scanning, computerized tomographic pulmonary angiography (CTPA), or venous duplex ultrasonography (DUS) over a 3-year period. Demographic information including age, pre- or postpartum status, history of prior VTE and family history of VTE were recorded.
RESULTS: Seventy patients were identified. 33 were prepartum and 38 postpartum (1 was evaluated both pre- and postpartum). Thirty-seven had respiratory symptoms. 42 patients had leg symptoms including 8 patients who had both and were included above. All but one prepartum patient underwent DUS (32/33) of which 2 (6%)were positive for deep venous thrombosis (DVT). Seventeen patients had respiratory symptoms: 8 underwent CTPA and one had a VQ scan. Only one study (11%)was positive for pulmonary embolism (PE). Chest radiography was performed in 6 prepartum women with respiratory symptoms. These were normal in 2, in 2 showed pneumonia, effusion in one, and fluid overload in one. In postpartum women, DUS was performed initially in 23 patients of which 2 were positive for DVT (9%). CTPA was obtained in 19 patients and was positive in 2 (10.5%). One patient had a nondiagnostic scan and underwent pulmonary angiography confirming PE. Overall, the incidence of VTE was 9% prepartum and 13.2% postpartum. All but one of the patients with VTE received DVT prophylaxis prior to diagnosis.
CONCLUSION: The yield of diagnostic studies for VTE is similar to our non-obstetrical population and higher than in non-pregnant women in this age group. This suggests that VTE is common during and after pregnancy. Pneumonia and fluid overload were also seen frequently in obstetrical patients with symptoms suggestive of thromboembolism.
CLINICAL IMPLICATIONS: Given the high maternal mortality of untreated VTE, patients should be thoroughly evaluated, initially with DUS, folowed by chest radiography if there are respiratory symptoms. Those with negative studies should undergo further testing for VTE.
DISCLOSURE: Tasbirul Islam, No Financial Disclosure Information; No Product/Research Disclosure Information