PULMONARY EMBOLISM investigation of choice in pregnancy
a) Ventilation/perfusion (V/Q) lung scan
b) Computerised tomography pulmonary angiogram (CTPA)
c) ECG and CXR
d) Compression duplex ultrasound
e) D-dimer
Correct Answer: a and b CTPA or V/Q lung scan both are correct - RCOG Guidelines (2015)
Any woman with symptoms and/or signs suggestive of VTE should have objective testing performed expeditiously and treatment with low-molecular-weight heparin (LMWH) given until the diagnosis is excluded by objective testing, unless treatment is strongly contraindicated.
Women presenting with symptoms and signs of an acute PE should have an electrocardiogram (ECG) and a chest X-ray (CXR) performed. In women with suspected PE who also have symptoms and signs of DVT, compression duplex ultrasound should be performed. If compression ultrasonography confirms the presence of DVT, no further investigation is necessary and treatment for VTE should continue.
In women with suspected PE without symptoms and signs of DVT, a ventilation/perfusion (V/Q) lung scan or a computerised tomography pulmonary angiogram (CTPA) should be performed. When the chest X-ray is abnormal and there is a clinical suspicion of PE, CTPA should be performed in preference to a V/Q scan.
Women with suspected PE should be advised that, compared with CTPA, V/Q scanning may carry a slightly increased risk of childhood cancer but is associated with a lower risk of maternal breast cancer; in both situations, the absolute risk is very small. D-dimer testing should not be performed in the investigation of acute VTE in pregnancy.