Diagnosis of Deep Vein Thrombosis and Pulmonary Embolism in Pregnancy and Postpartum: Should we Modify the Usual Diagnostic Strategy?

Abstract

In pregnant and postpartum patients, the incidence of venous thromboembolism (VTE) is increased three to fivefold compared with non-pregnant women of the same age, and deep venous thrombosis (DVT) and pulmonary embolism (PE) are leading causes of maternal mortality during pregnancy and postpartum. Early and accurate diagnosis is essential as unnecessary anticoagulation is not without risk. However, the diagnosis of VTE among these women is complicated by difficulties in clinical diagnosis and the concerns regarding radiation exposure of the fetus. Many of the common diagnostic tests, including D-dimer, compression ultrasonography, ventilation-perfusion scintigraphy and helical computed tomography that have been extensively investigated in non-pregnant patients, have not been appropriately validated in pregnancy. This article will review the role of various diagnostic tests in case of suspected VTE in pregnancy and puerperium, and issues such as radiation risk are discussed. Recommendations for the use of D-dimer and imaging techniques in pregnant and postpartum patients with a clinically suspected DVT or PE are provided.