{"title":"Severe Acute Pulmonary Embolism in Pregnancy.","authors":"Dr Bhaskar Narayan","doi":"10.1016/j.clinme.2024.100274","DOIUrl":null,"url":null,"abstract":"<p><p>Pulmonary embolism is a significant cause of morbidity and mortality in pregnancy and the puerperium. In severe cases, it causes haemodynamic instability and can lead to cardiac arrest due to obstructive shock. Patients with acute PE can be risk-stratified, to guide their monitoring and treatment; this article focuses on intermediate and high-risk PE. The criteria for defining high-risk PE can be used unmodified in pregnancy. Diagnostic imaging should not be delayed due to pregnancy. LMWH and UFH can be used during pregnancy and breastfeeding and systemic thrombolysis can be used in obstetric patients, but there are significant bleeding risks and it should be reserved for high-risk PE with hypotension and shock. Although pregnancy and the puerperium are risk factors for PE, it is important to avoid early diagnostic closure, and to consider other causes for the patient's presentation.</p>","PeriodicalId":10492,"journal":{"name":"Clinical Medicine","volume":" ","pages":"100274"},"PeriodicalIF":3.6000,"publicationDate":"2024-12-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Clinical Medicine","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1016/j.clinme.2024.100274","RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"MEDICINE, GENERAL & INTERNAL","Score":null,"Total":0}
引用次数: 0
Abstract
Pulmonary embolism is a significant cause of morbidity and mortality in pregnancy and the puerperium. In severe cases, it causes haemodynamic instability and can lead to cardiac arrest due to obstructive shock. Patients with acute PE can be risk-stratified, to guide their monitoring and treatment; this article focuses on intermediate and high-risk PE. The criteria for defining high-risk PE can be used unmodified in pregnancy. Diagnostic imaging should not be delayed due to pregnancy. LMWH and UFH can be used during pregnancy and breastfeeding and systemic thrombolysis can be used in obstetric patients, but there are significant bleeding risks and it should be reserved for high-risk PE with hypotension and shock. Although pregnancy and the puerperium are risk factors for PE, it is important to avoid early diagnostic closure, and to consider other causes for the patient's presentation.
肺栓塞是妊娠期和产褥期发病和死亡的一个重要原因。严重时会导致血流动力学不稳定，并可能因阻塞性休克而导致心跳骤停。可对急性 PE 患者进行风险分级，以指导其监测和治疗；本文重点讨论中危和高危 PE。高危 PE 的定义标准可在妊娠期不加修改地使用。不应因妊娠而延误诊断性影像学检查。妊娠期和哺乳期可使用 LMWH 和 UFH，产科病人可使用全身溶栓治疗，但存在显著的出血风险，应仅限于伴有低血压和休克的高危 PE。虽然妊娠和产褥期是导致 PE 的危险因素，但重要的是要避免早期诊断关闭，并考虑患者发病的其他原因。
期刊介绍：
Clinical Medicine is aimed at practising physicians in the UK and overseas and has relevance to all those managing or working within the healthcare sector.
Available in print and online, the journal seeks to encourage high standards of medical care by promoting good clinical practice through original research, review and comment. The journal also includes a dedicated continuing medical education (CME) section in each issue. This presents the latest advances in a chosen specialty, with self-assessment questions at the end of each topic enabling CPD accreditation to be acquired.
ISSN: 1470-2118 E-ISSN: 1473-4893 Frequency: 6 issues per year
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