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Venous Thromboembolism in Pregnancy

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Pulmonary Problems in Pregnancy

Part of the book series: Respiratory Medicine ((RM))

Pregnancy is a hypercoagulable state accompanied by changes in maternal physiology that also contribute to an increased risk of thrombosis. Diagnosis and treatment of venous thromboembolism (deep venous thrombosis and pulmonary embolism) during pregnancy present unique challenges. In non-pregnant patients, there is ample clinical research upon which recommendations are based, but there is a paucity of data in pregnancy resulting in difficulties in establishing specific recommendations. Management of pregnancy associated venous thromboembolism (VTE) is further complicated by the potential effects of diagnostic testing and therapy on the fetus, the lack of validation of therapeutic interventions in pregnancy, and by patient and provider fears.

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References

  1. Carson JL, Kelley MA, Duff A, Weg JG, Fulkerson WJ, Palevsky HI et al. The clinical course of pulmonary embolism. N Engl J Med 1992;326:1240–1245.

    Article  PubMed  CAS  Google Scholar 

  2. Samuelsson E, Hellgren M, Hogberg U. Pregnancy related deaths due to pulmonary embolism in Sweden. Acta Obstetrica et Gynecologia 2007;86:435–443.

    Article  Google Scholar 

  3. Biaggi A, Paradisi G, Ferrazzani S, De Carolis S, Lucchese A, Caruso A. Maternal mortality in Italy, 1980–1996. Eur J Obstet Gynecol Repro Biol 2004;114:144–149.

    Article  Google Scholar 

  4. Panting-Kemp A, Geller SE, Ngyen T, Simonson L, Nuwayhid B, Castro L. Maternal deaths in an urban perinatal network, 1992–1998. Am J Obstet Gynecol 2000;183(5):207–1212.

    Article  Google Scholar 

  5. Sullivan EA, Ford JB, Chambers G, Slaytor EK. Maternal mortality in Australia, 1973–1996. Aust N Z J Obstet Gynaecol 2004; 44:452–457.

    Article  PubMed  Google Scholar 

  6. Why mothers die 2000–2002. The Sixth Report of the confidential enquiries into maternal deaths in the United Kingdom. Gwyneth Lewis (Director and Editor), James Drife, MD (Clinical Director), RCOG Press of the Royal College of Obstetricians and Gynaecologists, London, CEMACH November 2004.

    Google Scholar 

  7. Atrash HK, Koonin LM, Lawson HW, Franks AL, Smith JC. Maternal mortality in the United States, 1979–1986. Obstet Gynecol 1990;76:1055–1060.

    PubMed  CAS  Google Scholar 

  8. de Swiet M. Maternal mortality: confidential enquiries into maternal deaths in the United Kingdom. Am J Obstet Gynecol 2000;182:760–766.

    Article  PubMed  Google Scholar 

  9. Rochat RW, Koonin LM, Atrash HK, Jewett JF. Maternal mortality in the United States: report from the Maternal Mortality Collaborative. Obstet Gynecol 1988;72:91–97.

    PubMed  CAS  Google Scholar 

  10. Andersen BS, Steffensen FH, Sorensen HT, Nielsen GL, Olsen J. The cumulative incidence of venous thromboembolism during pregnancy and puerperium. An 11 year Danish population – based study of 63,300 pregnancies. Acta Obstet Gynecol Scand 1998;77:170–173.

    CAS  Google Scholar 

  11. Treffers PE, Huidekoper BL, Weenink GH, et al. Epidemiologic observations of thromboembolic disease during pregnancy and in the puerperium in 56,022 women. Int J Gynaecol Obstet.1983;21:327–331.

    Article  PubMed  CAS  Google Scholar 

  12. Gherman RB, Goodwin TM, Leung B, Byrne JD, Hethumumi R, Montoro M. Incidence, clinical characteristics, and timing of objectively diagnosed venous thromboembolism during pregnancy. Obstet Gynecol 1999;94:730–734.

    Article  PubMed  CAS  Google Scholar 

  13. Simpson EL, Lawrenson RA, Nightingale AL, Farmer RD. Venous thromboembolism in pregnancy and the puerperium: incidence and additional risk factors from a London perinatal database. Br J Obstet Gynecol 2001;108:56–60.

    Article  CAS  Google Scholar 

  14. Anderson FA, Jr., Wheeler HB, Goldberg RJ, Hosmer DW, Patwardhan NA, Jovanovic B et al. A population-based perspective of the hospital incidence and case-fatality rates of deep vein thrombosis and pulmonary embolism. The Worcester study. Arch Intern Med 1991;151:933–938.

    Article  PubMed  Google Scholar 

  15. James AH, Tapson VF, Goldhaber SZ. Thrombosis during pregnancy and the postpartum period. Am J Ostet Gynecol 2005;193:216–219.

    Article  Google Scholar 

  16. Rutherford SE, Phelan JP. Deep venous thrombosis and pulmonary embolism in pregnancy. Obstet Gynecol Clin North Am 1991;18:345–370.

    PubMed  CAS  Google Scholar 

  17. Clark P, Brennand J, Conkie JA, McCall F, Greer IA, Walker ID. Activated protein C sensitivity, protein C, protein S and coagulation in normal pregnancy. Thromb Haemost 1998;79:1166–1170.

    PubMed  CAS  Google Scholar 

  18. Macklon NS, Greer IA, Bowman AW. An ultrasound study of gestational and postural changes in the deep venous system of the leg in pregnancy. Br J Obstet Gynaecol 1997;104:191–197.

    Article  PubMed  CAS  Google Scholar 

  19. Ray JG, Chan WS. Deep vein thrombosis during pregnancy and the puerperium: a meta-analysis of the period of risk and the leg of presentation. Obstet Gynecol Surv 1999;54:265–271.

    Article  PubMed  CAS  Google Scholar 

  20. Bergqvist A, Bergqvist D, Matzsch T, Lindhagen A. Late symptoms after pregnancy-related deep vein thrombosis. Br J Obstet Gynaecol 1990;97:338–341.

    Article  PubMed  CAS  Google Scholar 

  21. Carr MH, Towers CV, Eastenson AR, Pircon RA, Iriye BK, Adashek JA. Prolonged bed rest during pregnancy : Does the risk of deep vein thrombosis warrant the use of routine Heparin prophylaxis? J Mat Fet Med 1997;6:264–267.

    Article  CAS  Google Scholar 

  22. Blanco-Molina A, Trujillo-Santos J, Criado J, Lopez L, Lecumberri R, Gutierrez R, Monreal M, for the RIETE Investigators*. Venous thromboembolism during pregnancy or postpartum: findings from the RIETE Registry. Thromb Haemost 2007;97(2):186–190.

    PubMed  CAS  Google Scholar 

  23. McColl MD, Ramsay JE, Tait RC, Walker ID, McCall F, Conkie JA et al. Risk factors for pregnancy associated venous thromboembolism. Thromb Haemost 1997;78:1183–1188.

    PubMed  CAS  Google Scholar 

  24. Danilenko-Dixon DR, Heit JA, Silverstein MD, Yawn BP, Petterson TM, Lohse CM et al. Risk factors for deep vein thrombosis and pulmonary embolism during pregnancy or post-partum: a population-based, case-control study. Am J Obstet Gynecol 2001;184:104–110.

    Article  PubMed  CAS  Google Scholar 

  25. Macklon NS, Greer IA. Venous thromboembolic disease in obstetrics and gynaecology: the Scottish experience. Scott Med J 1996;41:83–86.

    PubMed  CAS  Google Scholar 

  26. Gerhardt A, Scharf RE, Beckmann MW, Struve S, Bender HG, Pillny M et al. Prothrombin and factor V mutations in women with a history of thrombosis during pregnancy and the puerperium. N Engl J Med 2000;342:374–380.

    Article  PubMed  CAS  Google Scholar 

  27. Martinelli I, De Stefano V, Taioli E, Paciaroni K, Rossi E, Mannucci PM. Inherited thrombophilia and first venous thromboembolism during pregnancy and puerperium. Thromb Haemost 2002;87:791–795.

    PubMed  CAS  Google Scholar 

  28. Brill-Edwards P, Ginsberg JS, Gent M, Hirsh J, Burrows RF, Kearon C et al. Safety of withholding heparin in pregnant women with a history of venous thromboembolism. Recurrence of Clot in This Pregnancy Study Group. N Engl J Med 2000;343:1439–1444.

    Article  PubMed  CAS  Google Scholar 

  29. Dahlback B. Inherited thrombophilia: resistance to activated protein C as a pathogenic factor of venous thromboembolism. Blood 1995;85:607–614.

    PubMed  CAS  Google Scholar 

  30. Dahlback B. Factor V gene mutation causing inherited resistance to activated protein C as a basis for venous thromboembolism. J Intern Med 1995;237:221–227.

    Article  PubMed  CAS  Google Scholar 

  31. Svensson PJ, Dahlback B. Resistance to activated protein C as a basis for venous thrombosis. N Engl J Med 1994;330:517–522.

    Article  PubMed  CAS  Google Scholar 

  32. Bertina RM, Koeleman BP, Koster T, Rosendaal FR, Dirven RJ, De Ronde H et al. Mutation in blood coagulation factor V associated with resistance to activated protein C. Nature 1994;369:64–67.

    Article  PubMed  CAS  Google Scholar 

  33. Voorberg J, Roelse J, Koopman R, Buller HR, Berends F, ten Cate JW et al. Association of idiopathic venous thromboembolism with single point- mutation at Arg506 of factor V. Lancet 1994;343:1535–1536.

    Article  PubMed  CAS  Google Scholar 

  34. De Stefano V, Finazzi G, Mannucci PM. Inherited thrombophilia: pathogenesis, clinical syndromes, and management. Blood 1996;87:3531–3544.

    PubMed  Google Scholar 

  35. Florell SR, Rodgers GM. Inherited thrombotic disorders: an update. Am J Hematol 1997;54:53–60.

    Article  PubMed  CAS  Google Scholar 

  36. Walker MC, Garner PR, Keely EJ, Rock GA, Reis MD. Changes in activated protein C resistance during normal pregnancy. Am J Obstet Gynecol 1997;177:162–169.

    Article  PubMed  CAS  Google Scholar 

  37. Lin J, August P. Genetic thrombophilias and preeclampsia: a meta-analysis. Obstet Gynecol 2005;105:182–192.

    Article  PubMed  Google Scholar 

  38. Howley HE, Walker M, Rodger MA. A systematic review of the association between factor V Leiden or prothrombin gene variant and intrauterine growth restriction. Am J Obstet Gynecol 2005;192:694–708.

    Article  PubMed  CAS  Google Scholar 

  39. Alfirevic Z, Roberts D, Martlew V. How strong is the association between maternal thrombophilia and adverse pregnancy outcome? A systematic review. Eur J Obstet Gynecol Reprod Biol 2002;101:6–14.

    Article  PubMed  Google Scholar 

  40. Kovalevsky G, Gracia CR, Berlin JA, Sammel MD, Barnhart KT. Evaluation of the association between hereditary thrombophilias and recurrent pregnancy loss. A meta-analysis. Arch Intern Med 2004;164:558–563.

    Article  Google Scholar 

  41. Gerhardt A, Scharf RE, Beckmann MW, Struve S, Bender HG, Pillny M et al. Prothrombin and factor V mutations in women with a history of thrombosis during pregnancy and the puerperium. N Engl J Med 2000;342:374–380.

    Article  PubMed  CAS  Google Scholar 

  42. McColl MD, Ellison J, Reid F, Tait RC, Walker ID, Greer IA. Prothrombin 20210 G-->A, MTHFR C677T mutations in women with venous thromboembolism associated with pregnancy. Br J Obstet Gynecol 2000;107:565–569.

    Article  CAS  Google Scholar 

  43. Brenner B, Mandel H, Lanir N, Younis J, Rothbart H, Ohel G et al. Activated protein C resistance can be associated with recurrent fetal loss. Br J Haematol 1997;97:551–554.

    Article  PubMed  CAS  Google Scholar 

  44. Asherson RA, Khamashta MA, Ordi-Ros J, et al. The “primary” antiphospholipid syndrome: major clinical and serologic features. Medicine (Baltimore) 1989;68:366–374.

    CAS  Google Scholar 

  45. Alarcon-Segovia D, Perez-Vasquez ME, Villa AR, Drenkard C, Cabiedes J. Preliminary classification criteria for the antiphospholipid syndrome within systemic lupus erythematosus. Semin Arthritis Rheum 1992;21:275–286.

    Article  PubMed  CAS  Google Scholar 

  46. Pierangeli SS, Chen PP, Gonzalez EB. Antiphospholipid antibodies and the antiphospholipid syndrome: an update on treatment and pathogenic mechanisms. Curr Opin Hematol 2006;13:366–375.

    PubMed  CAS  Google Scholar 

  47. Miyakis S, Lockshin MD, Atsumi T, et al. International consensus statement on an update of the classification criteria for definite antiphospholipid syndrome (APS). J Thromb Haemost 2006:4:295–306. (This paper summarizes evidence-based revision of the preliminary consensus criteria of 1999).

    Article  PubMed  CAS  Google Scholar 

  48. Branch DW, Silver RM, Blackwell JL, Reading JC, Scott JR. Outcome of treated pregnancies in women with antiphospholipid syndrome: an update of the Utah experience. Obstet Gynecol 1992;80:614–620.

    PubMed  CAS  Google Scholar 

  49. Lima F, Khamashta MA, Buchanan NMM, et al. A study of sixty pregnancies in patients with the antiphospholipid syndrome. Clin Exp Rheumatol 1996;14:131–136.

    PubMed  CAS  Google Scholar 

  50. Rosene-Montella K. Hypercoagulable states in pregnancy. Curr Obstet Med 1993;2:141–161.

    Google Scholar 

  51. Schafer AI. The hypercoagulable states. Ann Intern Med 1985;102:814–828.

    PubMed  CAS  Google Scholar 

  52. Hughes GRV. The antiphospholipid syndrome: ten years on. Lancet 1993:342:341–344.

    Article  PubMed  CAS  Google Scholar 

  53. Toubi E, Khamashta MA, Panarra A, Hughes GR. Association of antiphospholipid antibodies with central nervous system disease in systemic lupus erythematosus. Am J Med 1995:99:397–401.

    Article  PubMed  CAS  Google Scholar 

  54. Bakker RC, Brandjes DP. Hyperhomocysteinaemia and associated disease. Pharm World Sci 1997;19:126–132.

    Article  PubMed  CAS  Google Scholar 

  55. Ray JG, Shmorgun D, Chan WS. Common C677T polymorphism of the methylenetetrahydrofolate reductase gene and the risk of venous thromboembolism: meta-analysis of 31 studies. Pathophysiol Haemost Thromb 2002;32:51–58.

    Article  PubMed  CAS  Google Scholar 

  56. Walker MC, Smith GN, Perkins SL, Keely EJ, Garner PR. Changes in homocysteine levels during normal pregnancy. Am J Obstet Gynecol 1999;180:660–664.

    Article  PubMed  CAS  Google Scholar 

  57. Wells PS, Langlois NJ, Webster MA, Jaffey J, Anderson JL. Elevated factor VIII is a risk factor for idiopathic venous thromboembolism in Canada – is it necessary to define a new upper reference range for factor VIII? Thromb Haemost 2005;93:842–846.

    PubMed  CAS  Google Scholar 

  58. Wells PS, Hirsh J, Anderson DR, Lensing AWA, Foster G, Kearon C et al. Accuracy of clinical assessment of deep-vein thrombosis. Lancet 1995;345:1326–1330.

    Article  PubMed  CAS  Google Scholar 

  59. Wells PS, Anderson DR, Bormanis J, Guy F, Mitchell M, Gray L et al. Value of assessment of pretest probability of deep-vein thrombosis in clinical management. Lancet 1997;350:1795–1798.

    Article  PubMed  CAS  Google Scholar 

  60. Elkus R, Popovich J. respiratory physiology in pregnancy. Clin Chest Med 1992;13:555–565.

    PubMed  CAS  Google Scholar 

  61. Hytten F. Blood volume changes in normal pregnancy. Clin Haematol 1985;14:601–612.

    Google Scholar 

  62. Lee W. Cardiorespiratory alterations during pregnancy. Crit Care Clin 1991;7:763–775.

    PubMed  CAS  Google Scholar 

  63. Weinberger SE, Weiss ST, Cohen WR et al. Pregnancy and the lung: state of the art. Am Rev Respir Dis 1980;121:559–581.

    PubMed  Google Scholar 

  64. Crapo RO. Normal cardiopulmonary physiology during pregnancy. Clin Obstet Gynecol 1996;39(1): 3–16.

    Article  PubMed  CAS  Google Scholar 

  65. Templeton A, Kelman GR. Maternal blood gases (PAO2-PaO2), physiological shunt and VD/VT in normal pregnancy. Br J Anaesth 1976;48:1001–1004.

    Article  PubMed  Google Scholar 

  66. Stein PD, Terrin ML, Hales CA, Palevsky HI, Saltzman HA, Thompson BT et al. Clinical, laboratory, roentgenographic, and electrocardiographic findings in patients with acute pulmonary embolism and no pre-existing cardiac or pulmonary disease. Chest 1991;100:598–603.

    Article  PubMed  CAS  Google Scholar 

  67. Stein PD, Saltzman HA, Weg JG. Clinical characteristics of patients with acute pulmonary embolism. Am J Cardiol 1991;68:1723–1724.

    Article  PubMed  CAS  Google Scholar 

  68. Susec O, Jr., Boudrow D, Kline JA. The clinical features of acute pulmonary embolism in ambulatory patients. Acad Emerg Med 1997;4:891–897.

    Article  PubMed  Google Scholar 

  69. Manganelli D, Palla A, Donnamaria V, Giuntini C. Clinical features of pulmonary embolism. Doubts and certainties. Chest 1995;107:25S–32S.

    CAS  Google Scholar 

  70. Hull RD, Raskob G, Carter CJ, Coates G, Gill GJ, Sackett DL et al. Pulmonary embolism in outpatients with pleuritic chest pain. Arch Intern Med 1988;148:838–844.

    Article  PubMed  CAS  Google Scholar 

  71. Anderson FA, Jr., Wheeler HB. Venous thromboembolism. Risk factors and prophylaxis. Clin Chest Med 1995;16:235–251.

    Google Scholar 

  72. PIOPED Investigators. Value of the ventilation/perfusion scan in acute pulmonary embolism. Results of the prospective investigation of pulmonary embolism diagnosis (PIOPED). JAMA 1990;263:2753–2759.

    Article  Google Scholar 

  73. Perrier A, Desmarais S, Miron MJ, de Moerloose P, Lepage R, Slosman D et al. Non-invasive diagnosis of venous thromboembolism in outpatients. Lancet 1999;353:190–195.

    Article  PubMed  CAS  Google Scholar 

  74. Wicki J. Perneger TV. Junod AF. Bounameaux H. Perrier A. Assessing clinical probability of pulmonary embolism in the emergency ward: a simple score. Arch Intern Med 2001;161(1):92–97.

    Article  PubMed  CAS  Google Scholar 

  75. Wells PS, Anderson DR, Rodger MA, Stiell I, Dreyer JF, Barnes D et al. Excluding pulmonary embolism at the bedside without diagnostic imaging: management of patients with suspected pulmonary embolism presenting to the emergency department by using a simple clinical model and D-dimer. Ann Intern Med 2001;135:98–107.

    PubMed  CAS  Google Scholar 

  76. Wells PS, Anderson DR, Rodger MA, Ginsberg JS, Kearon C, Gent M et al. Derivation of a simple clinical model to categorize patients probability of pulmonary embolism: increasing the models utility with the SimpliRED D-dimer. Thromb Haemost 2000;83:416–420.

    PubMed  CAS  Google Scholar 

  77. Powrie RO. Larson L. Rosene-Montella K. Abarca M. Barbour L. Trujillo N. Alveolar-arterial oxygen gradient in acute pulmonary embolism in pregnancy. [erratum appears in Am J Obstet Gynecol 1999 Aug;181(2):510]. Am J Obstet Gynecol 1998 Feb;178(2):394–396.

    Article  PubMed  CAS  Google Scholar 

  78. Toglia MR, Weg JG. Venous thromboembolism during pregnancy. N Engl J Med 1996; 335:108–114.

    Article  PubMed  CAS  Google Scholar 

  79. Ginsberg JS, Hirsh J, Rainbow AJ et al. Risks to the fetus of radiologic procedures used in the diagnosis of venous thromboembolic disease. Thromb Haemost 1989;61:189–96.

    PubMed  CAS  Google Scholar 

  80. International Commission on Radiological Protection Publication 84. Pregnancy and medical radiation. Ann ICRP 2000;30:1–43.

    Google Scholar 

  81. National Commission on Radiation Protection Report #54. Medical Radiation Exposure of pregnant and Potentially Pregnant Women. Washington, DC: National Commission on Radiation Protection; 1997.

    Google Scholar 

  82. Fidler JL, Patz Jr EF, Ravin CE. Cardiopulmonary complications of pregnancy: radiographic findings. AJR Am J Roentgenol 1993;161:937–942.

    PubMed  CAS  Google Scholar 

  83. Chan WS. Ray JG. Murray S. Coady GE. Coates G. Ginsberg JS. Suspected pulmonary embolism in pregnancy: clinical presentation, results of lung scanning, and subsequent maternal and pediatric outcomes. Arch Intern Med 2002;162(10):1170–1175.

    Article  PubMed  CAS  Google Scholar 

  84. Balan KK, Critchley M, Vedavathy KK, Smith ML, Vinjamuri S. The value of ventilation-perfusion imaging in pregnancy. Br J Radiol 1997;70(832):338–340.

    PubMed  CAS  Google Scholar 

  85. Yoo D, Lazarus E, Khalil H, Bourjeily G, Noto RB, Mayo-Smith WW. Diagnostic Yield of Ventilation Perfusion (V/Q) Scans in Pregnancy: Review of the Findings in 315 Consecutive Pregnant Patients from 1999 through 2006. Presented at RSNA meeting November 2007.

    Google Scholar 

  86. Quiroz R, Kucher N, Zou K, Kipfmueller F, Costello P, Goldhaber S and Schoepf UJ Clinical validity of a negative computed tomography scan in patients with suspected pulmonary embolism: A systematic review. JAMA 2005;293(16):2012–2017.

    Article  PubMed  CAS  Google Scholar 

  87. Schoepf UJ, Kucher N, Kipfmueller F, Quiroz R, Costello P, Goldhaber S. Right ventricular enlargement on chest computed tomography: a predictor of early death in acute pulmonary embolism. Circulation 2004;110(20):3276–3280.

    Article  PubMed  Google Scholar 

  88. van Erkel AR. van Rossum AB. Bloem JL. Kievit J. Pattynama PM. Spiral CT angiography for suspected pulmonary embolism: a cost-effectiveness analysis. Radiology 1996 Oct;201(1):29–36.

    PubMed  Google Scholar 

  89. Doyle NM. Ramirez MM. Mastrobattista JM. Monga M. Wagner LK. Gardner MO. Diagnosis of pulmonary embolism: a cost-effectiveness analysis. Am J Obstet Gynecol 2004;191(3):1019–1023.

    Article  PubMed  Google Scholar 

  90. Moores LK, Jackson WL, Shorr AF, Jackson JL. Metaanalysis: outcomes in patients with suspected pulmonary embolism managed with computed tomographic pulmonary angiography. Ann Intern Med 2004;141:866–874.

    PubMed  Google Scholar 

  91. Stein PD, Fowler SE, Goodman LR, Gottschalk A, Hales CA, Hull RD, Leeper KV, Popovich J Jr, Quinn DA, Sos TA, Sostman HD, Tapson VF, Wakefield TW, Weg JG, Woodard PK, for the PIOPED II investigators. Multidetector computed tomography for acute pulmonary embolism, N Eng J Med 2006;354(22):2317–2327.

    Article  CAS  Google Scholar 

  92. Khalil H, Bourjeily G, Lazarus E, Yoo D, Mayo-Smith W. Multidetector CT Pulmonary Angiograms in Pregnant Patients: The “Limited, No Central PE” – How Limited? Presented at RSNA meeting, November 2007.

    Google Scholar 

  93. Bourjeily G, Khalil H, Habr F, Miller M, Rosene-Montella K. Multidetector-row computed tomography in the detection of pulmonary embolism in pregnancy. Chest 2007;132(4):500S.

    Google Scholar 

  94. Winer-Muram HT. Boone JM. Brown HL. Jennings SG. Mabie WC. Lombardo GT. Pulmonary embolism in pregnant patients: fetal radiation dose with helical CT. Radiology 2002;224(2):487–492.

    Article  PubMed  Google Scholar 

  95. Schoepf UJ, Costello P. CT angiography for the diagnosis of pulmonary embolism: state of the art. Radiology 2004;230:329–337.

    Article  PubMed  Google Scholar 

  96. Schoepf UJ, Holzknecht N, Helmberger TK, Crispin A, Hong C, Becker C, Reiser M. Subsegmental pulmonary emboli: improved detection with thin collimation multidetector row spiral CT. Radiology 2002;222:483–490.

    Article  PubMed  Google Scholar 

  97. Land CE, Tokunaga M, Tokuoka S, Nakmura N. Early onset breast cancer in A-bomb survivors. Lancet 1993;342:237.

    Article  PubMed  CAS  Google Scholar 

  98. Brenner DJ, Elliston CD, Hall EJ, Berdon WE. Estimated risk of radiation-induced fatal cancer from pediatric CT. AJR 2001;176:289–296.

    PubMed  CAS  Google Scholar 

  99. Tubiana M. Carcinogenic effects of low radiation doses. Cancer Radiother 1999;3:203–214.

    Article  PubMed  CAS  Google Scholar 

  100. American Cancer Society. Cancer facts and figures. Atlanta, Ga: Am Cancer Society, 1994.

    Google Scholar 

  101. Tokunaga M, Land CE, Tokuoka S, Nishimori I, Soda M, Akiba S. Incidence of female breast cancer among atomic bomb survivors, 1950–1985. Radiat Res 1994;138:209–223.

    Article  PubMed  CAS  Google Scholar 

  102. Hopper KD. King SH. Lobell ME. TenHave TR. Weaver JS. The breast: in-plane x-ray protection during diagnostic thoracic CT – shielding with bismuth radioprotective garments. Radiology 1997;205(3):853–858.

    PubMed  CAS  Google Scholar 

  103. Parker MS, Hui FK, Camacho MA, Chung JK, Broga DW, Sethi NN. Female breast radiation exposure during CT pulmonary angiography. AJR 2005;185:1228–1233.

    Article  PubMed  Google Scholar 

  104. Einstein AJ, Hanzlova MJ, Rajagopalan S. Estimating the risk of cancer associated with radiation exposure from 64-slice computed tomography coronary angiography. JAMA 2007;298(3):317–323.

    Article  PubMed  CAS  Google Scholar 

  105. Remy-Jardin M, Pistolesi M, Goodman LR et al. Management of suspected acute pulmonary embolism in an era of CT angiography: a statement of the Fleischner Society. Radiology 2007;245(2):315–329.

    Article  PubMed  Google Scholar 

  106. Goodman LR. Small pulmonary emboli: what do we know? Radiology 2005; 234(3):654–658.

    Article  PubMed  Google Scholar 

  107. Hatabu H, Uematsu H, Nguyen B, Miller WT, Jr, Hasegawa I, Gefter WB. CT and MR in pulmonary embolism: a changing role for nuclear medicine in diagnostic strategy. Semin Nucl Med 2002;32:183–192.

    Article  PubMed  Google Scholar 

  108. Gupta A, Frazer CK, Ferguson JM, et al. Acute pulmonary embolism: diagnosis with MR angiography. Radiology 1999;210:353–359.

    PubMed  CAS  Google Scholar 

  109. Meaney JF, Weg JG, Chenevert TL, Stafford-Johnson D, Hamilton BH, Prince MR. Diagnosis of pulmonary embolism with magnetic resonance angiography. N Engl J Med. 1997;336:1422–1427.

    Article  PubMed  CAS  Google Scholar 

  110. Kluge A, Luboldt W, Bachmann G. Acute pulmonary embolism to the subsegmental level: diagnostic accuracy of three MRI techniques compared with 16-MDCT. AJR Am J Roentgenol. 2006;187:W7–W14.

    Article  Google Scholar 

  111. Novak Z, Thurmond AS, Ross PL, Jones MK, Thornburg KL, Katzberg RW. Gadolinium-DTPA transplacental transfer and distribution in fetal tissue in rabbits. Invest Radiol 1993;28:828–830.

    PubMed  CAS  Google Scholar 

  112. Marcos HB, Semelka RC, Worawattanakul S. Normal placenta: gadolinium-enhanced dynamic MR imaging. Radiology 1997;205:493–496.

    PubMed  CAS  Google Scholar 

  113. Barkhof F, Heijboer RJ, Algra PR: Inadvertent i.v. administration of gadopentetate dimeglumine during early pregnancy [letter]. Am J Roentgenol 1992;158:1171.

    CAS  Google Scholar 

  114. Kubik-Huch RA, Gottstein-Aalame NM, Frenzel T, Seifert B, Puchert E, Wittek S, Debatin JF: Gadopentetate dimeglumine excretion into human breast milk during lactation. Radiology 2000;216:555–558.

    PubMed  CAS  Google Scholar 

  115. Hull RD, Raskob GE, Carter CJ. Serial impedance plethysmography in pregnant patients with clinically suspected deep-vein thrombosis: clinical validity of negative findings. Ann Intern Med 1990;112(9):663–667.

    PubMed  CAS  Google Scholar 

  116. Anderson DR, Lensing AW, Wells PS, Levine MN, Weitz JI, Hirsh J. Limitations of impedance plethysmography in the diagnosis of clinically suspected deep-vein thrombosis. Ann Intern Med 1993 Jan; 1;118(1):25–30.

    PubMed  CAS  Google Scholar 

  117. Wells PS, Hirsh J, Anderson DR, et al. Comparison of the accuracy of impedance plethysmography and compression ultrasonography in outpatients with clinically suspected deep vein thrombosis. A two centre paired-design prospective trial. Thromb Haemost 1995 Dec; 74(6):1423–1427.

    CAS  Google Scholar 

  118. Cogo A, Lensing AWA, Koopman MMW, Piovella F, Siragusa S, Wells PS et al. Compression ultrasonography for diagnostic management of patients with clinically suspected deep vein thrombosis: prospective cohort study. Br Med J 1998;316:17–20.

    Article  CAS  Google Scholar 

  119. Le Gal G, Prins AM, Righini M et al. Diagnostic value of a negative single complete compression ultrasound of the lower limbs to exclude the diagnosis of deep venous thrombosis in pregnant and post-partum women: a retrospective hospital based study. Thromb Res 2006;118:691–697.

    Article  PubMed  CAS  Google Scholar 

  120. Rodger MA. Avruch LI. Howley HE. Olivier A. Walker MC. Pelvic magnetic resonance venography reveals high rate of pelvic vein thrombosis after cesarean section. Am J Obstet Gynecol 2006;194(2):436–437.

    Article  PubMed  Google Scholar 

  121. Wells PS, Anderson DR, Ginsberg JS. Assessment of deep vein thrombosis or pulmonary embolism by the combined use of clinical model and non-invasive diagnostic tests. Semin Thromb Hemost 2000;26:643–656.

    Article  PubMed  CAS  Google Scholar 

  122. British Thoracic Society Standards of Care Committee Pulmonary Embolism Guideline Development Group. British Thoracic Society guidelines for the management of suspected acute pulmonary embolism. Thorax 2003;58:470–484.

    Article  Google Scholar 

  123. ATS Guidelines: The diagnostic approach to acute venous thromboembolism. Am J Respir Crit Care Med 1999;160:1043.

    Google Scholar 

  124. Torres JA, Aracil E, Puras E et al. Role of venous duplex imaging of lower extremity for pulmonary embolism diagnosis. Angiologia 1999;51:71–76.

    Google Scholar 

  125. Turkstra F, Kuijer PM, van Beek EJ, Brandjes DP, ten Cate JW, Buller HR. Diagnostic utility of ultrasonography of leg veins in patients suspected of having pulmonary embolism. Ann Intern Med 1997;126(10):775–781.

    PubMed  CAS  Google Scholar 

  126. Barrelier M, Lezin B, Landy S et al. Prevalence of duplex ultrasonography detectable venous thrombosis in patients with suspected or acute pulmonary embolism. J Mal Vac 2001;26:23–30.

    Google Scholar 

  127. MacGillavry M, Sanson B, Buller H et al. Compression ultrasonography of the leg veins in patients with clinically suspected pulmonary embolism: is a more extensive assessment of compressibility useful? Thromb Haemost 2000;884:973–976.

    Google Scholar 

  128. Scarsbrook AF, Evans AL, Owen AR, Gleeson FV. Diagnosis of suspected venous thromboembolic disease in pregnancy. Clin Radiol 2006 Jan;61(1):1–12.

    Article  PubMed  CAS  Google Scholar 

  129. Chan WS, Ginsberg JS. Diagnosis of deep venous thrombosis and pulmonary embolism in pregnancy. Thromb Res 2002;107:85–91.

    Article  PubMed  CAS  Google Scholar 

  130. PIOPED II investigators. Diagnostic pathways in acute pulmonary embolism: Recommendations of the PIOPED II investigators. Radiology 2007;242:15–21.

    Article  Google Scholar 

  131. Patel SJ, Reede DL, Katz, DS, Subramaniam R, Amorosa JK. Imaging the pregnant patient for nonobstetric conditions: Algorithms and radiation dose considerations. RadioGraphics. 2007;27:1705–1722.

    Article  PubMed  Google Scholar 

  132. Kearon C. Diagnosis of pulmonary embolism. CMAJ 2003;168(2):183–194.

    PubMed  Google Scholar 

  133. Hull R, Hirsh J, Sackett DL, et al. Clinical validity of a negative venogram in patients with clinically suspected venous thrombosis. Circulation 1981;64:622–625.

    Article  PubMed  CAS  Google Scholar 

  134. Katz DS, Hon M. Current DVT imaging. Techn Vasc Interv Radiol 2004;7(2):55–62.

    Article  Google Scholar 

  135. Rademaker J. Griesshaber V. Hidajat N. Oestmann JW. Felix R. Combined CT pulmonary angiography and venography for diagnosis of pulmonary embolism and deep vein thrombosis: radiation dose. J Thorac Imaging 2001;16(4):297–299.

    Article  PubMed  CAS  Google Scholar 

  136. Moody AR. Magnetic resonance direct thrombus imaging. J Thromb Haemost 2003;1:1403–1409.

    Article  PubMed  CAS  Google Scholar 

  137. 137. Moody A, Wastie M, Gregson R, Whitaker S. Diagnostic accuracy of direct MR imaging of pulmonary emboli compared to conventional pulmonary angiography. Radiol 1997;268(Suppl):205.

    Google Scholar 

  138. Sukhija R. Aronow WS. Lee J. Kakar P. McClung JA. Levy JA. Belkin RN. Association of right ventricular dysfunction with in-hospital mortality in patients with acute pulmonary embolism and reduction in mortality in patients with right ventricular dysfunction by pulmonary embolectomy. Am J Cardiol;2005;95(5):695–696.

    Article  PubMed  Google Scholar 

  139. Binder L. Pieske B. Olschewski M. Geibel A. Klostermann B. Reiner C. Konstantinides S. N-terminal pro-BNP or troponin testing followed by echocardiography for risk stratification of acute pulmonary embolism.Circulation 2005;112(11):1573–1579.

    Article  PubMed  CAS  Google Scholar 

  140. Ten Wolde M. Sohne M. Quak E. Mac Gillavry MR. Buller HR. Prognostic value of echocardiographically assessed right ventricular dysfunction in patients with pulmonary embolism. Arch Intern Med 2004;164(15):1685–1689.

    Article  PubMed  Google Scholar 

  141. Roy PM. Colombet I. Durieux P. Chatellier G. Sors H. Meyer G. Systematic review and meta-analysis of strategies for the diagnosis of suspected pulmonary embolism. Br Med J 2005;331(7511):259.

    Article  Google Scholar 

  142. Elkhayam U, Gleicher N. Cardiac evaluation during pregnancy. In: Cardiac problems in pregnancy. Eds Elkhayam U and Gleicher N, 3rd edition, Wiley-Liss, 1998.

    Google Scholar 

  143. Kline JA, Runyon MS, Webb WB, Jones AE, Mitchell AM. Prospective study of the Simplify D-dimer assay for pulmonary embolism in emergency department patients. Chest 2006;129:1417–1423.

    Article  PubMed  Google Scholar 

  144. Writing group for the Christopher Study Investigators. Effectiveness of managing suspected pulmonary embolism using an algorithm combining clinical probability, D-dimer testing and computed tomography. JAMA 2006;295(2):172–179.

    Article  Google Scholar 

  145. Perrier A. Roy PM. Sanchez O. Le Gal G. Meyer G. Gourdier AL. Furber A. Revel MP. Howarth N. Davido A. Bounameaux H. Multidetector-row computed tomography in suspected pulmonary embolism.N Engl J Med 2005;352(17):1760–1768.

    Article  PubMed  CAS  Google Scholar 

  146. Eichinger S. D-dimer testing in pregnancy. Pathophysiol Haemost Thromb 33(5–6):327–9, 2003 Sep–2004 Dec.

    Google Scholar 

  147. Boehlen F. Epiney M. Boulvain M. Irion O. de Moerloose P. Changes in D-dimer levels during pregnancy and the postpartum period: results of two studies. Medicale Suisse 2005;1(4):296–298.

    CAS  Google Scholar 

  148. Morse M. Establishing a normal range for D-dimer levels through pregnancy to aid in the diagnosis of pulmonary embolism and deep vein thrombosis. J Thromb Haemost 2004;2:1202–1204.

    Article  PubMed  CAS  Google Scholar 

  149. Bombeli T. Raddatz-Mueller P. Fehr J. Coagulation activation markers do not correlate with the clinical risk of thrombosis in pregnant women. Am J ObstetGynecol 2001;184(3):382–389.

    Article  CAS  Google Scholar 

  150. Chan WS, Chunilal S, Lee A, Crowther M, Rodger M, Ginsberg JS. A red blood cell agglutination D-dimer test to exclude deep venous thrombosis in pregnancy. Ann Intern Med 2007;147:165–170.

    PubMed  Google Scholar 

  151. Meyer G. Roy PM. Sors H. Sanchez O. Laboratory tests in the diagnosis of pulmonary embolism. Respiration 2003;70(2):125–132.

    Article  PubMed  Google Scholar 

  152. Meyer, T, Binder, L, Hruska, N, et al. Cardiac troponin I elevation in acute pulmonary embolism is associated with right ventricular dysfunction. J Am Coll Cardiol 2000;36:1632–1636.

    Article  PubMed  CAS  Google Scholar 

  153. Giannitsis, E, Muller-Bardorff, M, Kurowski, V, et al. Independent prognostic value of cardiac troponin T in patients with confirmed pulmonary embolism. Circulation 2000;102,211–217.

    PubMed  CAS  Google Scholar 

  154. Kucher N, Printzen G, Doernhoefer T, Windecker S, Meier B, Hess OM. Low pro-brain natriuretic peptide levels predict benign clinical outcome in acute pulmonary embolism. Circulation 2003;107:1576–1578.

    Article  PubMed  Google Scholar 

  155. Kucher N, Printzen G, Goldhaber SZ. Prognostic role of brain natriuretic peptide in acute pulmonary embolism. Circulation 2003;107:2545–2547.

    Article  PubMed  CAS  Google Scholar 

  156. Pruszczyk P, Kostrubiec M, Bochowicz A, Styczynski G, Szulc M, Kurzyna M, Fijalkowska A, Kuch-Wocial A, Chlewicka I, Torbicki A. N-terminal pro-brain natriuretic peptide in patients with acute pulmonary embolism. Eur Resp J 2003;22:649–653.

    Article  CAS  Google Scholar 

  157. Ten Wolde M, Tulevski II, Mulder JW, Sohne M, Boomsma F, Mulder BJ, Buller HR. Brain natriuretic peptide as a predictor of adverse outcome in patients with acute pulmonary embolism. Circulation 2003;107:2082–2084.

    Article  PubMed  Google Scholar 

  158. Barker D, Williams S, Mason G, McLoughlin H, Schlosshan D, Tan L. Plasma brain natriuretic peptide may not be useful to assess possible cardiac symptoms during pregnancy: 248. Am J Obstet Gynecol 2006;193(6):79.

    Google Scholar 

  159. Kale A, Kale E, Yalinkaya A, Akdeniz N, Canoruc N. The comparison of amino-terminal probrain natriuretic peptide levels in preeclampsia and normotensive pregnancy. J Perinat Med 2005;33(2):121–124.

    Article  PubMed  CAS  Google Scholar 

  160. Resnik JL. Hong C. Resnik R. Kazanegra R. Beede J. Bhalla V. Maisel A. Evaluation of B-type natriuretic peptide (BNP) levels in normal and preeclamptic women. Am J Obstet Gynecol 2005;193(2):450–454.

    Article  PubMed  CAS  Google Scholar 

  161. Kaunitz AM, Hughes JM, Grimes DA, Smith JC, Rochat RW, Kafrissen ME. Causes of maternal mortality in the United States. Obstet Gynecol 1985;65:605–612.

    PubMed  CAS  Google Scholar 

  162. DHSS. Report on confidential inquiries: maternal deaths in England and Wales 1986–1988. 1991. London, Her Majesty's Station Office.

    Google Scholar 

  163. Levine MN, Hirsh J, Gent M, Turpie AGG, Cruickshank M, Weitz J et al. A randomized trial comparing activated thromboplastin time with heparin assay in patients with acute venous thromboembolism requiring large daily doses of heparin. Arch Intern Med 1994;154:49–55.

    Article  PubMed  CAS  Google Scholar 

  164. Couturaud F, Julian JA, Kearon C. Low molecular weight heparin administered once versus twice daily in patients with venous thromboembolism: a meta-analysis. Thromb Haemost 2001;86:980–984.

    PubMed  CAS  Google Scholar 

  165. Casele HL, Laifer SA, Woelkers DA, Venkataramanan R. Changes in the pharmacokinetics of the low-molecular-weight heparin enoxaparin sodium during pregnancy. Am J Obstet Gynecol 1999;181:1113–1117.

    Article  PubMed  CAS  Google Scholar 

  166. Hunt BJ, Doughty HA, Majumdar G, Copplestone A, Kerslake S, Buchanan N et al. Thromboprophylaxis with low molecular weight heparin (Fragmin) in high risk pregnancies. Thromb Haemost 1997;77:39–43.

    PubMed  CAS  Google Scholar 

  167. Brieger D, Dawes J. Long-term persistence of biological activity following administration of Enoxaparin sodium (clexane) is due to sequestration of antithrombin- binding low molecular weight fragments – comparison with unfractionated heparin. Thromb Haemost 1996;75:740–746.

    PubMed  CAS  Google Scholar 

  168. Ginsberg JS, Hirsh J. Use of antithrombotic agents during pregnancy. Chest 1998;114:524S–530S.

    Article  PubMed  CAS  Google Scholar 

  169. Dolovich LR, Ginsberg JS, Douketis JD, Holbrook AM, Cheah G. A meta-analysis comparing low-molecular-weight Heparins with unfractionated heparin in the treatment of venous thromboembolism: examining some unanswered questions regarding location of treatment, product type, and dosing frequency. Arch Intern Med 2000;160:181–188.

    Article  PubMed  CAS  Google Scholar 

  170. Gould MK, Dembitzer AD, Doyle RL, Hastie TJ, Garber AM. Low-molecular-weight Heparins compared with unfractionated heparin for treatment of acute deep venous thrombosis. A Meta-analysis of randomized, controlled trials. Ann Intern Med 1999;130:800–809.

    CAS  Google Scholar 

  171. Pettila V, Leinonen P, Markkola A, Hiilesmaa V, Kaaja R. Postpartum bone mineral density in women treated for thromboprophylaxis with unfractionated heparin or LMW heparin. Thromb Haemost 2002;87:182–186.

    PubMed  CAS  Google Scholar 

  172. Greer IA, Nelson-Piercy C. Low-molecular-weight heparins for thromboprophylaxis and treatment of venous thromboembolism in pregnancy: a systematic review of safety and efficacy. Blood 2005;106:401–407.

    Article  PubMed  CAS  Google Scholar 

  173. Malcolm JC, Keely EJ, Karovitch AJ, Wells PS. Use of low molecular weight heparin in acute venous thromboembolic events in pregnancy. J Obstet Gynaecol Can. 2002;24:568–571.

    PubMed  Google Scholar 

  174. Warkentin TE, Greinacher A. Heparin-induced thrombocytopenia: recognition, treatment, and prevention: the Seventh ACCP Conference on Antithrombotic and Thrombolytic Therapy. Chest 2004;126:311S–337S.

    Article  PubMed  CAS  Google Scholar 

  175. Lepercq J, Conard J, Borel-Derlon A, Darmon JY, Boudignat O, Francoual C et al. Venous thromboembolism during pregnancy: a retrospective study of enoxaparin safety in 624 pregnancies. Br J Obstet Gyncol 2001;108:1134–1140.

    CAS  Google Scholar 

  176. Huhle G, Geberth M, Hoffmann U, Heene DL, Harenberg J. Management of heparin-associated thrombocytopenia in pregnancy with subcutaneous r-hirudin. Gynecol Obstet Invest 2000;49:67–69.

    Article  PubMed  CAS  Google Scholar 

  177. Payne SM, Kovacs MJ. Cutaneous dalteparin reactions associated with antibodies of heparin-induced thrombocytopenia. Ann Pharmacother 2003;37:655–658.

    Article  PubMed  Google Scholar 

  178. Howell R, Fidler J, Letsky E, de Swiet M. The risks of antenatal subcutaneous heparin prophylaxis: a controlled trial. Br J Obstet Gynaecol 1983;90:1124–1128.

    Article  PubMed  CAS  Google Scholar 

  179. Bar J, Cohen-Sacher B, Hod M, Blickstein D, Lahav J, Merlob P. Low-molecular-weight heparin for thrombophilia in pregnant women. Int J Gynaecol Obstet 2000;69:209–213.

    Article  PubMed  CAS  Google Scholar 

  180. Richter C, Sitzmann J, Lang P, Weitzel H, Huch A, Huch R. Excretion of low molecular weight heparin in human milk. Br J Clin Pharmacol 2001;52:708–710.

    Article  PubMed  CAS  Google Scholar 

  181. Chan WS, Anand SS, Ginsberg JS. Anticoagulation of pregnant women with mechanical heart valves. Arch Intern Med 2000;160:191–196.

    Article  PubMed  CAS  Google Scholar 

  182. Hall JG, Pauli RM, Wilson KM. Maternal and fetal sequelae of anticoagulation during pregnancy. Am J Med 1980;68:122–140.

    Article  PubMed  CAS  Google Scholar 

  183. Kearon C, Hirsh J. Management of anticoagulation before and after elective surgery. N Engl J Med 1997;336:1506–1511.

    Article  PubMed  CAS  Google Scholar 

  184. Turrentine MA, Braems G, Ramirez MM. Use of thrombolytics for the treatment of thromboembolic disease during pregnancy. Obstet Gynecol Surv 1995;50:534–541.

    Article  PubMed  CAS  Google Scholar 

  185. Lindqvist PG, Svensson PJ, Marsaal K, Grennert L, Luterkort M, Dahlback B. Activated protein C resistance (FV:Q506) and pregnancy. Thromb Haemost 1999;81:532–537.

    PubMed  CAS  Google Scholar 

  186. Bates SM, Greer IA, Hirsh JA, Ginsberg JS. Use of antithrombotic agents during pregnancy. The seventh ACCP conference on antithrombotics and thrombolytics in pregnancy. Chest 2004;126:627–644.

    Google Scholar 

  187. DeStefano, et al. Pregnancy Related Venous thromboembolism. Br J Hem 2006;135:386–391.

    Article  Google Scholar 

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  1. Chief, Department of Medicine Women & Infants Hospital Professor of Medicine and Obstetrics & Gynecology, The Warren Alpert Medical School of Brown University, 101 Dudley Street, Providence, RI, USA

    Karen Rosene-Montella

  2. Assistant Professor of Medicine, Pulmonary and Critical Care Medicine Department of Medicine, The Warren Alpert Medical School of Brown University Women & Infants Hospital, 100 Dudley Street, Providence, RI, USA

    Ghada Bourjeily

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    Rosene-Montella, K., Bourjeily, G. (2009). Venous Thromboembolism in Pregnancy. In: Rosene-Montella, K., Bourjeily, G. (eds) Pulmonary Problems in Pregnancy. Respiratory Medicine. Humana Press. https://doi.org/10.1007/978-1-59745-445-2_18

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