Pulmonary Embolism in Pregnancy
Investigation of suspected pulmonary embolism in pregnant patient is similar to that in non-pregnant patients, beginning with duplex ultrasound. False-positive results may occur because of venous occlusion by the enlarged uterus. Ventilation-perfusion scanning and CT angiogram can be carried out with a low risk for fetal radiation exposure.
Unfractionated heparin and low molecular-weight heparin are safe and effective in pregnancy.
Warfarin is usually avoided because of the risk for embryopathy with first-trimester use and central nervous system abnormalities and bleeding risk with second- and third-trimester use.
Thrombolysis has been used successfully during pregnancy and the postpartum period but should be limited to life-threatening situations.