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Diagnosis and Management of Pulmonary Embolism in Pregnancy

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Abstract

Dyspnea is a common presenting complaint of pregnancy with a wide differential diagnosis. Clinicians must be aware of the physiologic alterations of pregnancy and recognize when the degree of symptoms and clinical findings is out of proportion to typical physiologic changes of pregnancy. Dyspnea, chest pain, and hemodynamic changes can indicate a variety of different pathologies including dyspnea of normal pregnancy, asthma, respiratory infections, pre-eclampsia, acute coronary and vascular syndromes, peripartum cardiomyopathy (PPCM), amniotic fluid embolism (AFE), and pulmonary embolism (PE). Appropriate physical exam, history, and testing can narrow this differential. When diagnosed, pulmonary embolism should be managed with anticoagulation. Massive pulmonary embolism should prompt the clinician to consider thrombolysis. In patients unable to undergo systemic thrombolysis, catheter-directed therapy is emerging as an alternative. In pregnant women who undergo catastrophic and refractory respiratory or hemodynamic collapse unresponsive to typical critical care support, extracorporeal membrane oxygenation (ECMO) can be considered.

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  1. Departments of Medicine and Emergency Medicine, Division of Critical Care Medicine, Cooper University Hospital, Cooper Medical School of Rowan University, Camden, NJ, USA

    Lars-Kristofer N. Peterson

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    Jennifer A. LaRosa

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Peterson, LK.N. (2019). Diagnosis and Management of Pulmonary Embolism in Pregnancy. In: LaRosa, J. (eds) Adult Critical Care Medicine. Springer, Cham. https://doi.org/10.1007/978-3-319-94424-1_17

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