Decoding Pulmonary Embolism Evaluation During Pregnancy

December 9, 2022

The following quiz question is based on the article, “Decoding Pulmonary Embolism Evaluation During Pregnancy,” published in ACEP Now in May of 2022. Test your understanding!

The diagnosis of pulmonary embolism (PE) during pregnancy can be tricky. Although uncommon, its symptoms may overlap with normal symptoms of pregnancy. Moreover, D-dimer levels normally increase during pregnancy; imaging with CT pulmonary angiogram (CTPA) or ventilation-perfusion scans imparts ionizing radiation to both the mother and fetus.

The author of the article provides an easy to use algorithm on the management of the pregnant patient in need of evaluation for possible pulmonary embolism.

Which of the following does the author of the article argue is the MOST reasonable approach to assessing such pregnant patients with potential PE, based on new data?

A) Evaluate the need for CTPA via a Revised Geneva Score (RGS) and D-dimer threshold of more than 0.5 mg/L.

B) Use the version of the YEARS algorithm adapted for pregnancy, using the algorithm to help gauge the need for imaging.

C) Order CTPA in all pregnant patients with potential PE, even if PE is not the most likely diagnosis in their clinical context, the patient has no symptoms of deep vein thrombosis, and their D-dimer is less than 1.0 mg/L.

D) Use the PE Rule Out Criteria (PERC) to rule out PE. If not ruled out, proceed with CTPA.

None