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Published in: Journal of Thrombosis and Thrombolysis 3/2014

01-04-2014

Pulmonary embolism in pregnancy

Authors: E. Conti, L. Zezza, E. Ralli, C. Comito, L. Sada, J. Passerini, D. Caserta, S. Rubattu, C. Autore, M. Moscarini, M. Volpe

Published in: Journal of Thrombosis and Thrombolysis | Issue 3/2014

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Abstract

Venous thromboembolism (VTE) is a major cause of maternal morbidity and mortality during pregnancy or early after delivery, remaining a diagnostic and therapeutic challenge in both states. The absolute incidence of pregnancy-associated VTE has been reported as 1 in 1,000 to 1 in 2,000 deliveries. With 5–6 million new births computed in Europe in 2010, the potential clinical relevance of diagnosing and treating gravidic VTE is immediately evident. Fivefold higher in a pregnant as compared with a non-pregnant woman, VTE risk is also higher in postpartum than antepartum period. Ranked absolute and relative thrombotic risk may be described in the several thrombophilic conditions experienced by women at risk, according to which specific prophylactic and therapeutic recommendations have been formulated by recent guidelines. The main purpose of the present review article was to emphasize the most recent findings and recommendations in diagnostic strategies, discussing thrombophilic risk evaluation, as well as risks and benefits of various diagnostic techniques for both mother and fetus.
Literature
1.
go back to reference Cahill AG, Stout MJ, Macones GA et al (2009) Diagnosing pulmonary embolism in pregnancy using computed-tomographic angiography or ventilation-perfusion. Obstet Gynecol 114:124–129PubMed Cahill AG, Stout MJ, Macones GA et al (2009) Diagnosing pulmonary embolism in pregnancy using computed-tomographic angiography or ventilation-perfusion. Obstet Gynecol 114:124–129PubMed
2.
go back to reference Gherman RB, Goodwin TM, Leung B et al (1999) Incidence, clinical characteristics, and timing of objectively diagnosed venous thromboembolism during pregnancy. Obstet Gynecol 94:730–734PubMed Gherman RB, Goodwin TM, Leung B et al (1999) Incidence, clinical characteristics, and timing of objectively diagnosed venous thromboembolism during pregnancy. Obstet Gynecol 94:730–734PubMed
3.
go back to reference Rodger AA, Avruch LI, Howley HE et al (2006) Pelvic magnetic resonance venography reveals high rate of pelvic vein thrombosis after cesarean section. Am J Obstet Gynecol 107:468–470 Rodger AA, Avruch LI, Howley HE et al (2006) Pelvic magnetic resonance venography reveals high rate of pelvic vein thrombosis after cesarean section. Am J Obstet Gynecol 107:468–470
4.
go back to reference Merhi Z, Awonuga A (2006) Acute abdominal pain as the presenting symptom of isolated iliac vein thrombosis in pregnancy. Obstet Gynecol 107:460–470 Merhi Z, Awonuga A (2006) Acute abdominal pain as the presenting symptom of isolated iliac vein thrombosis in pregnancy. Obstet Gynecol 107:460–470
5.
go back to reference Heit JA, Kobbervig CE, James AH et al (2005) Trends in the incidence of venous thromboembolism during pregnancy or postpartum: a 30-year population-based study. Ann Intern Med 143:697–706PubMed Heit JA, Kobbervig CE, James AH et al (2005) Trends in the incidence of venous thromboembolism during pregnancy or postpartum: a 30-year population-based study. Ann Intern Med 143:697–706PubMed
6.
go back to reference O’Connor C, Moriarty J, Walsh J et al (2011) The application of a clinical risk stratification score may reduce unnecessary investigations for pulmonary embolism in pregnancy. J Matern Fetal Neonatal Med 24:1461–1464PubMed O’Connor C, Moriarty J, Walsh J et al (2011) The application of a clinical risk stratification score may reduce unnecessary investigations for pulmonary embolism in pregnancy. J Matern Fetal Neonatal Med 24:1461–1464PubMed
7.
go back to reference Eichinger S, Weltermann A, Philipp K et al (1999) Prospective evaluation of hemostatic system activation and thrombin potential in healthy pregnant women with and without factor V Leiden. Thromb Haemost 82:1232–1236PubMed Eichinger S, Weltermann A, Philipp K et al (1999) Prospective evaluation of hemostatic system activation and thrombin potential in healthy pregnant women with and without factor V Leiden. Thromb Haemost 82:1232–1236PubMed
8.
go back to reference Marik PE, Plante LA (2008) Venous thromboembolic disease and pregnancy. N Engl J Med 359:2025–2033PubMed Marik PE, Plante LA (2008) Venous thromboembolic disease and pregnancy. N Engl J Med 359:2025–2033PubMed
9.
go back to reference Macklon NS, Greer IA (1997) The deep venous system in the puerperium: an ultrasound study. Br J Obstet Gynecol 104:198–200 Macklon NS, Greer IA (1997) The deep venous system in the puerperium: an ultrasound study. Br J Obstet Gynecol 104:198–200
10.
go back to reference James AH, Bushnell CD, Jamison MG et al (2005) Incidence and risk factors for stroke in pregnancy and the puerperium. Obstet Gynecol 106:509–516PubMed James AH, Bushnell CD, Jamison MG et al (2005) Incidence and risk factors for stroke in pregnancy and the puerperium. Obstet Gynecol 106:509–516PubMed
11.
go back to reference James AH, Jamison MG, Biswas MS et al (2006) Acute myocardial infarction in pregnancy: a United States population-based study. Circulation 113:1564–1571PubMed James AH, Jamison MG, Biswas MS et al (2006) Acute myocardial infarction in pregnancy: a United States population-based study. Circulation 113:1564–1571PubMed
12.
go back to reference Bates SM (2011) Pregnancy-associated venous thromboembolism: prevention and treatment. Semin Hematol 48:271–284PubMed Bates SM (2011) Pregnancy-associated venous thromboembolism: prevention and treatment. Semin Hematol 48:271–284PubMed
13.
go back to reference Pomp ER, Lenselink AM, Rosendaal FR et al (2008) Pregnancy, the postpartum period and prothrombotic defects: risk of venous thrombosis in the MEGA study. J Thromb Haemost 6:632–637PubMed Pomp ER, Lenselink AM, Rosendaal FR et al (2008) Pregnancy, the postpartum period and prothrombotic defects: risk of venous thrombosis in the MEGA study. J Thromb Haemost 6:632–637PubMed
16.
go back to reference Saving Mothers’ Lives. Reviewing maternal deaths to make motherhood safer 2003–2005, Executive Summary and Key Recommendations, Confidential Enquiry into Maternal and Child Health, December 2007 Saving Mothers’ Lives. Reviewing maternal deaths to make motherhood safer 2003–2005, Executive Summary and Key Recommendations, Confidential Enquiry into Maternal and Child Health, December 2007
17.
go back to reference Cantwell R, Clutton-Brock T, Cooper G et al (2011) Saving mothers’ lives: reviewing maternal deaths to make motherhood safer: 2006–2008. The eighth report of the confidential enquiries into maternal deaths in the United Kingdom. BJOG 118(Suppl 1):1–203PubMed Cantwell R, Clutton-Brock T, Cooper G et al (2011) Saving mothers’ lives: reviewing maternal deaths to make motherhood safer: 2006–2008. The eighth report of the confidential enquiries into maternal deaths in the United Kingdom. BJOG 118(Suppl 1):1–203PubMed
18.
go back to reference Samuelsson E, Hedenmalm K, Persson I (2005) Mortality from venous thromboembolism in young Swedish women and its relation to pregnancy and use of oral contraceptives—an approach to specifying rates. Eur J Epidemiol 20:509–516PubMed Samuelsson E, Hedenmalm K, Persson I (2005) Mortality from venous thromboembolism in young Swedish women and its relation to pregnancy and use of oral contraceptives—an approach to specifying rates. Eur J Epidemiol 20:509–516PubMed
19.
go back to reference Bremme KA (2003) Haemostatic changes in pregnancy. Best Pract Res Clin Haematol 16:153–168PubMed Bremme KA (2003) Haemostatic changes in pregnancy. Best Pract Res Clin Haematol 16:153–168PubMed
20.
go back to reference James AH (2009) Venous thromboembolism in pregnancy. Arterioscler Thromb Vasc Biol 29:326–331PubMed James AH (2009) Venous thromboembolism in pregnancy. Arterioscler Thromb Vasc Biol 29:326–331PubMed
21.
go back to reference Ulander VM, Lehtola A, Kaaja R (2003) Long-term outcome of deep venous thrombosis during pregnancy treated with unfractionated heparin or low molecular weight heparin. Thromb Res 111:239–242PubMed Ulander VM, Lehtola A, Kaaja R (2003) Long-term outcome of deep venous thrombosis during pregnancy treated with unfractionated heparin or low molecular weight heparin. Thromb Res 111:239–242PubMed
22.
go back to reference James AH, Tapson VF, Goldhaber SZ (2005) Thrombosis during pregnancy and the postpartum period. Am J Obstet Gynecol 193:216–219PubMed James AH, Tapson VF, Goldhaber SZ (2005) Thrombosis during pregnancy and the postpartum period. Am J Obstet Gynecol 193:216–219PubMed
23.
go back to reference Gordon M (2002) Maternal physiology in pregnancy. In: Gabbe S, Niebyl J, Simpson J (eds) Normal and problem pregnancies, vol 4. Churchill Livingstone, New York, pp 63–92 Gordon M (2002) Maternal physiology in pregnancy. In: Gabbe S, Niebyl J, Simpson J (eds) Normal and problem pregnancies, vol 4. Churchill Livingstone, New York, pp 63–92
24.
go back to reference Macklon NS, Greer IA, Bowman AW (1997) An ultrasound study of gestational and postural changes in the deep venous system of the leg in pregnancy. Br J Obstet Gynecol 104:191–197 Macklon NS, Greer IA, Bowman AW (1997) An ultrasound study of gestational and postural changes in the deep venous system of the leg in pregnancy. Br J Obstet Gynecol 104:191–197
25.
go back to reference Whitty J, Dombrowski M (2002) Respiratory diseases in pregnancy. In: Gabbe S, Niebyl J, Simpson J (eds) Normal and Problem Pregnancies, vol 4. Churchill Livingstone, New York, pp 1033–1064 Whitty J, Dombrowski M (2002) Respiratory diseases in pregnancy. In: Gabbe S, Niebyl J, Simpson J (eds) Normal and Problem Pregnancies, vol 4. Churchill Livingstone, New York, pp 1033–1064
26.
go back to reference Danilenko-Dixon DR, Heit JA, Silverstein MD et al (2001) Risk factors for deep vein thrombosis and pulmonary embolism during pregnancy or post partum: a population-based, case-control study. Am J Obstet Gynecol 184:104–110PubMed Danilenko-Dixon DR, Heit JA, Silverstein MD et al (2001) Risk factors for deep vein thrombosis and pulmonary embolism during pregnancy or post partum: a population-based, case-control study. Am J Obstet Gynecol 184:104–110PubMed
27.
go back to reference Carr MH, Towers CV, Eastenson AR et al (1997) Prolonged bed rest during pregnancy: does the risk of deep vein thrombosis warrant the use of routine heparin prophylaxis? J Matern Fetal Med 6:264–267PubMed Carr MH, Towers CV, Eastenson AR et al (1997) Prolonged bed rest during pregnancy: does the risk of deep vein thrombosis warrant the use of routine heparin prophylaxis? J Matern Fetal Med 6:264–267PubMed
28.
go back to reference Kovacevich GJ, Gaich SA, Lavin JP et al (2000) The prevalence of thromboembolic events among women with extended bed rest prescribed as part of the treatment for premature labor or preterm premature rupture of membranes. Am J Obstet Gynecol 182:1089–1092PubMed Kovacevich GJ, Gaich SA, Lavin JP et al (2000) The prevalence of thromboembolic events among women with extended bed rest prescribed as part of the treatment for premature labor or preterm premature rupture of membranes. Am J Obstet Gynecol 182:1089–1092PubMed
30.
go back to reference Pabinger I, Grafenhofer H, Kyrle PA et al (2002) Temporary increase in the risk for recurrence during pregnancy in women with a history of venous thromboembolism. Blood 100:1060–1062PubMed Pabinger I, Grafenhofer H, Kyrle PA et al (2002) Temporary increase in the risk for recurrence during pregnancy in women with a history of venous thromboembolism. Blood 100:1060–1062PubMed
31.
go back to reference Brill-Edwards P, Ginsberg JS, Gent M et al (2000) Recurrence of clot in this pregnancy study group. Safety of withholding heparin in pregnant women with a history of venous thromboembolism. N Engl J Med 343:1439–1444PubMed Brill-Edwards P, Ginsberg JS, Gent M et al (2000) Recurrence of clot in this pregnancy study group. Safety of withholding heparin in pregnant women with a history of venous thromboembolism. N Engl J Med 343:1439–1444PubMed
32.
go back to reference Pabinger I, Grafenhofer H, Kaider A et al (2005) Risk of pregnancy-associated recurrent venous thromboembolism in women with a history of venous thrombosis. J Thromb Haemost 3:949–954PubMed Pabinger I, Grafenhofer H, Kaider A et al (2005) Risk of pregnancy-associated recurrent venous thromboembolism in women with a history of venous thrombosis. J Thromb Haemost 3:949–954PubMed
33.
go back to reference De Stefano V, Martinelli I, Rossi E et al (2006) The risk of recurrent venous thromboembolism in pregnancy and puerperium without antithrombotic prophylaxis. Br J Haematol 135:386–391PubMed De Stefano V, Martinelli I, Rossi E et al (2006) The risk of recurrent venous thromboembolism in pregnancy and puerperium without antithrombotic prophylaxis. Br J Haematol 135:386–391PubMed
34.
go back to reference Robertson L, Wu O, Langhorne P et al (2006) Thrombosis: risk and economic assessment of thrombophilia screening (TREATS) study. Thrombophilia in pregnancy: a systematic review. Br J Haematol 132:171–196PubMed Robertson L, Wu O, Langhorne P et al (2006) Thrombosis: risk and economic assessment of thrombophilia screening (TREATS) study. Thrombophilia in pregnancy: a systematic review. Br J Haematol 132:171–196PubMed
35.
go back to reference Bates SM, Greer IA, Pabinger I et al (2008) Venous thromboembolism, thrombophilia, antithrombotic therapy, and pregnancy: American College of Chest Physicians evidence-based clinical practice guidelines (8th Edition). Chest 133:844S–886SPubMed Bates SM, Greer IA, Pabinger I et al (2008) Venous thromboembolism, thrombophilia, antithrombotic therapy, and pregnancy: American College of Chest Physicians evidence-based clinical practice guidelines (8th Edition). Chest 133:844S–886SPubMed
36.
go back to reference Bates SM, Greer IA, Middeldorp S et al (2012) VTE, thrombophylia, antithrombotic therapy, and pregnancy: antithrombotic therapy and prevention of thrombosis, 9th ed: American College of Chest Physicians evidence-based clinical practice guidelines. Chest 141:e691s–e736sPubMedCentralPubMed Bates SM, Greer IA, Middeldorp S et al (2012) VTE, thrombophylia, antithrombotic therapy, and pregnancy: antithrombotic therapy and prevention of thrombosis, 9th ed: American College of Chest Physicians evidence-based clinical practice guidelines. Chest 141:e691s–e736sPubMedCentralPubMed
37.
go back to reference McColl MD, Ramsay JE, Tait RC et al (1997) Risk factors for pregnancy associated venous thromboembolism. Thromb Haemost 78(4):1183–1188PubMed McColl MD, Ramsay JE, Tait RC et al (1997) Risk factors for pregnancy associated venous thromboembolism. Thromb Haemost 78(4):1183–1188PubMed
38.
go back to reference Walker ID (1997) Congenital thrombophilia. Baillieres Clin Obstet Gynaecol 11:431–455PubMed Walker ID (1997) Congenital thrombophilia. Baillieres Clin Obstet Gynaecol 11:431–455PubMed
39.
go back to reference Friederich PW, Sanson BJ, Simioni P et al (1996) Frequency of pregnancy-related venous thromboembolism in anticoagulant factor-deficient women: implications for prophylaxis. Ann Intern Med 125(12):955–960PubMed Friederich PW, Sanson BJ, Simioni P et al (1996) Frequency of pregnancy-related venous thromboembolism in anticoagulant factor-deficient women: implications for prophylaxis. Ann Intern Med 125(12):955–960PubMed
40.
go back to reference Middeldorp S, Henkens CMA, Koopman MMW et al (1998) The incidence of venous thromboembolism in family members of patients with factor V Leiden mutation and venous thrombosis. Ann Intern Med 128(1):15–20PubMed Middeldorp S, Henkens CMA, Koopman MMW et al (1998) The incidence of venous thromboembolism in family members of patients with factor V Leiden mutation and venous thrombosis. Ann Intern Med 128(1):15–20PubMed
41.
go back to reference Simioni P, Sanson BJ, Prandoni P et al (1999) Incidence of venous thromboembolism in families with inherited thrombophilia. Thromb Haemost 81(2):198–202PubMed Simioni P, Sanson BJ, Prandoni P et al (1999) Incidence of venous thromboembolism in families with inherited thrombophilia. Thromb Haemost 81(2):198–202PubMed
42.
go back to reference Middeldorp S, Meinardi JR, Koopman MMW et al (2001) A prospective study of asymptomatic carriers of the factor V Leiden mutation to determine the incidence of venous thromboembolism. Ann Intern Med 135(5):322–327PubMed Middeldorp S, Meinardi JR, Koopman MMW et al (2001) A prospective study of asymptomatic carriers of the factor V Leiden mutation to determine the incidence of venous thromboembolism. Ann Intern Med 135(5):322–327PubMed
43.
go back to reference Couturaud F, Leroyer C, Mottier D, Groupe dEtude de la Thrombose de Bretagne Occidentale (G.E.T.B.O) (2008) Risk factors and clinical presentation of venous thromboembolism according to the age of relatives of patients with factor V Leiden. Thromb Haemost 99(4):793–794PubMed Couturaud F, Leroyer C, Mottier D, Groupe dEtude de la Thrombose de Bretagne Occidentale (G.E.T.B.O) (2008) Risk factors and clinical presentation of venous thromboembolism according to the age of relatives of patients with factor V Leiden. Thromb Haemost 99(4):793–794PubMed
44.
go back to reference Middeldorp S, Libourel EJ, Hamulyak K, van der Meer J, Buller HR (2001) The risk of pregnancy-related venous thromboembolism in women who are homozygous for factor V Leiden. Br J Haematol 113(2):553–555PubMed Middeldorp S, Libourel EJ, Hamulyak K, van der Meer J, Buller HR (2001) The risk of pregnancy-related venous thromboembolism in women who are homozygous for factor V Leiden. Br J Haematol 113(2):553–555PubMed
45.
go back to reference Martinelli I, Legnani C, Bucciarelli P, Grandone E, De Stefano V, Mannucci PM (2001) Risk of pregnancy-related venous thrombosis in carriers of severe inherited thrombophilia. Thromb Haemost 86(3):800–803PubMed Martinelli I, Legnani C, Bucciarelli P, Grandone E, De Stefano V, Mannucci PM (2001) Risk of pregnancy-related venous thrombosis in carriers of severe inherited thrombophilia. Thromb Haemost 86(3):800–803PubMed
46.
go back to reference Tormene D, Simioni P, Prandoni P et al (2001) Factor V leiden mutation and the risk of venous thromboembolism in pregnant women. Haematologica 86(12):1305–1309PubMed Tormene D, Simioni P, Prandoni P et al (2001) Factor V leiden mutation and the risk of venous thromboembolism in pregnant women. Haematologica 86(12):1305–1309PubMed
47.
go back to reference Bank I, Libourel EJ, Middeldorp S et al (2004) Prothrombin 20210A mutation: a mild risk factor for venous thromboembolism but not for arterial thrombotic disease and pregnancy-related complications in a family study. Arch Intern Med 164(17):1932–1937PubMed Bank I, Libourel EJ, Middeldorp S et al (2004) Prothrombin 20210A mutation: a mild risk factor for venous thromboembolism but not for arterial thrombotic disease and pregnancy-related complications in a family study. Arch Intern Med 164(17):1932–1937PubMed
48.
go back to reference Coppens M, van de Poel MH, Bank I et al (2006) A prospective cohort study on the absolute incidence of venous thromboembolism and arterial cardiovascular disease in asymptomatic carriers of the prothrombin 20210A mutation. Blood 108(8):2604–2607PubMed Coppens M, van de Poel MH, Bank I et al (2006) A prospective cohort study on the absolute incidence of venous thromboembolism and arterial cardiovascular disease in asymptomatic carriers of the prothrombin 20210A mutation. Blood 108(8):2604–2607PubMed
49.
go back to reference Lepercq J, Conard J, Borel-Derlon A et al (2001) Venous thromboembolism during pregnancy: a retrospective study of enoxaparin safety in 624 pregnancies. BJOG 108:1134–1140PubMed Lepercq J, Conard J, Borel-Derlon A et al (2001) Venous thromboembolism during pregnancy: a retrospective study of enoxaparin safety in 624 pregnancies. BJOG 108:1134–1140PubMed
50.
go back to reference Lindqvist P, Dahlback B, Marsal K (1999) Thrombotic risk during pregnancy: a population study. Obstet Gynecol 94:595–599PubMed Lindqvist P, Dahlback B, Marsal K (1999) Thrombotic risk during pregnancy: a population study. Obstet Gynecol 94:595–599PubMed
51.
go back to reference Simpson EL, Lawrenson RA, Nightingale AL et al (2001) Venous thromboembolism in pregnancy and the puerperium: incidence and additional risk factors from a London perinatal database. BJOG 108:56–60PubMed Simpson EL, Lawrenson RA, Nightingale AL et al (2001) Venous thromboembolism in pregnancy and the puerperium: incidence and additional risk factors from a London perinatal database. BJOG 108:56–60PubMed
52.
go back to reference Larsen TB, Sorensen HT, Gislum M et al (2007) Maternal smoking, obesity, and risk of venous thromboembolism during pregnancy and the puerperium: a population-based nested case-control study. Thromb Res 120:505–509PubMed Larsen TB, Sorensen HT, Gislum M et al (2007) Maternal smoking, obesity, and risk of venous thromboembolism during pregnancy and the puerperium: a population-based nested case-control study. Thromb Res 120:505–509PubMed
53.
go back to reference Jacobsen AF, Skjeldestad FE, Sandset PM (2008) Incidence and risk patterns of venous thromboembolism in pregnancy and puerperium—a register-based case-control study. Am J Obstet Gynecol 198:231–237 Jacobsen AF, Skjeldestad FE, Sandset PM (2008) Incidence and risk patterns of venous thromboembolism in pregnancy and puerperium—a register-based case-control study. Am J Obstet Gynecol 198:231–237
54.
go back to reference Hague WM, Dekker GA (2003) Risk factors for thrombosis in pregnancy. Best Pract Res Clin Haematol 16:197–210PubMed Hague WM, Dekker GA (2003) Risk factors for thrombosis in pregnancy. Best Pract Res Clin Haematol 16:197–210PubMed
55.
go back to reference Sia WW, Powrie RO, Cooper AB et al (2009) The incidence of deep vein thrombosis in women undergoing cesarean delivery. Thromb Res 123:550–555PubMed Sia WW, Powrie RO, Cooper AB et al (2009) The incidence of deep vein thrombosis in women undergoing cesarean delivery. Thromb Res 123:550–555PubMed
56.
go back to reference Revel MP, Cohen S, Sanchez O et al (2011) Pulmonary embolism during pregnancy: diagnosis with lung scintigraphy or CT angiography? Radiology 258:590–598PubMed Revel MP, Cohen S, Sanchez O et al (2011) Pulmonary embolism during pregnancy: diagnosis with lung scintigraphy or CT angiography? Radiology 258:590–598PubMed
57.
go back to reference Stein PD, Woodard PK, Weg JG et al (2007) PIOPED II investigators. Diagnostic pathways in acute pulmonary embolism: recommendations of the PIOPED II investigators. Radiology 242:15–21PubMed Stein PD, Woodard PK, Weg JG et al (2007) PIOPED II investigators. Diagnostic pathways in acute pulmonary embolism: recommendations of the PIOPED II investigators. Radiology 242:15–21PubMed
58.
go back to reference Freeman LM (2008) Don’t bury the V/Q scan: it’s as good as multidetector CT angiograms with a lot less radiation exposure. J Nucl Med 49:5–8PubMed Freeman LM (2008) Don’t bury the V/Q scan: it’s as good as multidetector CT angiograms with a lot less radiation exposure. J Nucl Med 49:5–8PubMed
59.
go back to reference To MS, Hunt BJ, Nelson-Piercy C (2008) A negative D-dimer does not exclude thromboembolism (VTE) in pregnancy. J Obstet Gynecol 28:222–223 To MS, Hunt BJ, Nelson-Piercy C (2008) A negative D-dimer does not exclude thromboembolism (VTE) in pregnancy. J Obstet Gynecol 28:222–223
60.
go back to reference Sivandarajah S (2011) Towards evidence-based emergency medicine: best BETs from the Manchester Royal Infirmary. BET 4: current evidence does not support the use of a negative D-dimer to rule out suspected pulmonary embolism in pregnancy. Emerg Med J 28:245–246PubMed Sivandarajah S (2011) Towards evidence-based emergency medicine: best BETs from the Manchester Royal Infirmary. BET 4: current evidence does not support the use of a negative D-dimer to rule out suspected pulmonary embolism in pregnancy. Emerg Med J 28:245–246PubMed
61.
go back to reference Kline JA, Williams GW, Hernandez-Nino J (2005) D-dimer concentrations in normal pregnancy: new diagnostic thresholds are needed. Clin Chem 51:825–829PubMed Kline JA, Williams GW, Hernandez-Nino J (2005) D-dimer concentrations in normal pregnancy: new diagnostic thresholds are needed. Clin Chem 51:825–829PubMed
62.
go back to reference Chan WS, Chunilal SD, Bates S et al (1999) The prevalence of positive soluble fibrin and D-dimer results in healthy asymptomatic pregnant women. Blood 94:20a Chan WS, Chunilal SD, Bates S et al (1999) The prevalence of positive soluble fibrin and D-dimer results in healthy asymptomatic pregnant women. Blood 94:20a
63.
go back to reference Sadigh G, Kelly AM, Cronin P (2011) Challenges, controversies, and hot topics in pulmonary embolism imaging. AJR Am J Roentgenol 196:497–515PubMed Sadigh G, Kelly AM, Cronin P (2011) Challenges, controversies, and hot topics in pulmonary embolism imaging. AJR Am J Roentgenol 196:497–515PubMed
64.
go back to reference Cutts BA, Dasgupta D, Hunt BJ (2012) New directions in the diagnosis and treatment of pulmonary embolism in pregnancy. Am J Obstet Gynecol 208:102–108PubMed Cutts BA, Dasgupta D, Hunt BJ (2012) New directions in the diagnosis and treatment of pulmonary embolism in pregnancy. Am J Obstet Gynecol 208:102–108PubMed
65.
go back to reference Chan WS, Lee A, Spencer FA et al (2010) D-dimer testing in pregnant patients: towards determining the next ‘level’ in the diagnosis of deep vein thrombosis. J Thromb Haemost 8:1004–1011PubMed Chan WS, Lee A, Spencer FA et al (2010) D-dimer testing in pregnant patients: towards determining the next ‘level’ in the diagnosis of deep vein thrombosis. J Thromb Haemost 8:1004–1011PubMed
66.
go back to reference Prisco D, Cam G, Falcani M (2005) Hemostatic changes in normal pregnancy. Haematol Meet Rep 1:1–5 Prisco D, Cam G, Falcani M (2005) Hemostatic changes in normal pregnancy. Haematol Meet Rep 1:1–5
67.
go back to reference Jeremiah ZA, Adias TC, Opiah M et al (2012) Elevation in D-dimer concentrations is positively correlated with gestation in normal uncomplicated pregnancy. Int J Womens Health 4:437–443PubMedCentralPubMed Jeremiah ZA, Adias TC, Opiah M et al (2012) Elevation in D-dimer concentrations is positively correlated with gestation in normal uncomplicated pregnancy. Int J Womens Health 4:437–443PubMedCentralPubMed
68.
go back to reference Kovac M, Mikovic Z, Rakicevic L et al (2010) The use of D-dimer with new cutoff can be useful in diagnosis of venous thromboembolism in pregnancy. Eur J Obstet Gynecol Reprod Biol 148:27–30PubMed Kovac M, Mikovic Z, Rakicevic L et al (2010) The use of D-dimer with new cutoff can be useful in diagnosis of venous thromboembolism in pregnancy. Eur J Obstet Gynecol Reprod Biol 148:27–30PubMed
69.
go back to reference Vinayakamoorthy V, Geary S, Ganatra R (2010) A United Kingdom based survey of clinical practice in the diagnosis of suspected pulmonary embolism. Nucl Med Commun 31:112–120PubMed Vinayakamoorthy V, Geary S, Ganatra R (2010) A United Kingdom based survey of clinical practice in the diagnosis of suspected pulmonary embolism. Nucl Med Commun 31:112–120PubMed
70.
go back to reference Leung AN, Bull TM, Jaeschke R et al (2012) On behalf of the ATS/STR committee on pulmonary embolism in pregnancy. American Thoracic Society Documents: an official American thoracic society/society of thoracic radiology clinical practice guideline-evaluation of suspected pulmonary embolism in pregnancy. Radiology 262:635–646PubMed Leung AN, Bull TM, Jaeschke R et al (2012) On behalf of the ATS/STR committee on pulmonary embolism in pregnancy. American Thoracic Society Documents: an official American thoracic society/society of thoracic radiology clinical practice guideline-evaluation of suspected pulmonary embolism in pregnancy. Radiology 262:635–646PubMed
71.
go back to reference The Task Force on the Management of Cardiovascular Diseases during Pregnancy of the European Society of Cardiology (ESC) Endorsed by the European Society of Gynecology (ESG), the Association for European Paediatric Cardiology (AEPC), and the German Society for Gender Medicine (DGesGM) (2011) ESC Guidelines on the management of cardiovascular diseases during pregnancy. Eur Heart J 32:3147–3197 The Task Force on the Management of Cardiovascular Diseases during Pregnancy of the European Society of Cardiology (ESC) Endorsed by the European Society of Gynecology (ESG), the Association for European Paediatric Cardiology (AEPC), and the German Society for Gender Medicine (DGesGM) (2011) ESC Guidelines on the management of cardiovascular diseases during pregnancy. Eur Heart J 32:3147–3197
72.
go back to reference Cogley JR, Ghobrial PM, Chandrasekaran B et al (2012) Pulmonary embolism evaluation in the pregnant patient: a review of current imaging approaches. Semin Ultrasound CT MRI 33:11–17 Cogley JR, Ghobrial PM, Chandrasekaran B et al (2012) Pulmonary embolism evaluation in the pregnant patient: a review of current imaging approaches. Semin Ultrasound CT MRI 33:11–17
73.
go back to reference Rosenberg VA, Lockwood CJ (2007) Thromboembolism in pregnancy. Obstet Gynecol Clin North Am 34:481–500PubMed Rosenberg VA, Lockwood CJ (2007) Thromboembolism in pregnancy. Obstet Gynecol Clin North Am 34:481–500PubMed
74.
go back to reference Shahir K, Goodman LR, Tali A et al (2010) Pulmonary embolism in pregnancy: CT pulmonary angiography versus perfusion scanning. AJR Am J Roentgenol 195:214–222 Shahir K, Goodman LR, Tali A et al (2010) Pulmonary embolism in pregnancy: CT pulmonary angiography versus perfusion scanning. AJR Am J Roentgenol 195:214–222
75.
go back to reference Stein PD, Fowler SE, Goodman LR et al (2006) Multidetector computed tomography for acute pulmonary embolism. N Engl J Med 354:2317–2327PubMed Stein PD, Fowler SE, Goodman LR et al (2006) Multidetector computed tomography for acute pulmonary embolism. N Engl J Med 354:2317–2327PubMed
76.
go back to reference Chunilal SD, Bates SM (2009) Venous thromboembolism in pregnancy: diagnosis, management and prevention. Thromb Haemost 101:428–438PubMed Chunilal SD, Bates SM (2009) Venous thromboembolism in pregnancy: diagnosis, management and prevention. Thromb Haemost 101:428–438PubMed
77.
go back to reference Nijkeuter M, Geleijns J, De Roos A et al (2004) Diagnosing pulmonary embolism in pregnancy: rationalizing fetal radiation exposure in radiological procedures. J Thromb Haemost 2:1857–1858PubMed Nijkeuter M, Geleijns J, De Roos A et al (2004) Diagnosing pulmonary embolism in pregnancy: rationalizing fetal radiation exposure in radiological procedures. J Thromb Haemost 2:1857–1858PubMed
78.
go back to reference Ahmet A, Lawson ML, Babyn P et al (2009) Hypothyroidism in neonates post-iodinated contrast media: a systematic review. Acta Paediatr 98:1568–1574PubMed Ahmet A, Lawson ML, Babyn P et al (2009) Hypothyroidism in neonates post-iodinated contrast media: a systematic review. Acta Paediatr 98:1568–1574PubMed
79.
go back to reference Hagen PJ, Hartmann IJ, Hoekstra OS et al (2003) ANTELOPE study group. Comparison of observer variability and accuracy of different criteria for lung scan interpretation. J Nucl Med 44:739–744PubMed Hagen PJ, Hartmann IJ, Hoekstra OS et al (2003) ANTELOPE study group. Comparison of observer variability and accuracy of different criteria for lung scan interpretation. J Nucl Med 44:739–744PubMed
80.
go back to reference Sostman HD, Stein PD, Gottschalk A et al (2008) Acute pulmonary embolism: sensitivity and specificity of ventilation-perfusion scintigraphy in PIOPED II study. Radiology 246:941–946PubMed Sostman HD, Stein PD, Gottschalk A et al (2008) Acute pulmonary embolism: sensitivity and specificity of ventilation-perfusion scintigraphy in PIOPED II study. Radiology 246:941–946PubMed
81.
go back to reference Bajc M, Neilly JB, Miniati M et al (2009) EANM guidelines for ventilation/perfusion scintigraphy. Part 1. Pulmonary imaging with ventilation/perfusion single photon emission tomography. Eur J Nucl Med Mol Imaging 36:1356e70 Bajc M, Neilly JB, Miniati M et al (2009) EANM guidelines for ventilation/perfusion scintigraphy. Part 1. Pulmonary imaging with ventilation/perfusion single photon emission tomography. Eur J Nucl Med Mol Imaging 36:1356e70
82.
go back to reference Leblanc M, Leveillée F, Turcotte E (2007) Prospective evaluation of the negative predictive value of V/Q SPECT using 99mTc-Technegas. Nucl Med Commun 28:667–672PubMed Leblanc M, Leveillée F, Turcotte E (2007) Prospective evaluation of the negative predictive value of V/Q SPECT using 99mTc-Technegas. Nucl Med Commun 28:667–672PubMed
83.
go back to reference Freeman L, Blaufox D (2010) SPECT V/Q imaging of the lungs. Semin Nucl Med 40:393e4 Freeman L, Blaufox D (2010) SPECT V/Q imaging of the lungs. Semin Nucl Med 40:393e4
84.
go back to reference Bourjeily G, Chalhoub M, Phornphutkul C et al (2010) Neonatal thyroid function: effect of a single exposure to iodinated contrast medium in utero. Radiology 256:744–750PubMed Bourjeily G, Chalhoub M, Phornphutkul C et al (2010) Neonatal thyroid function: effect of a single exposure to iodinated contrast medium in utero. Radiology 256:744–750PubMed
85.
go back to reference ICRP (1998) Radiation dose to patients from radiopharmaceuticals (addendum 2 to ICRP 53). Ann ICRP 28:1–126 ICRP (1998) Radiation dose to patients from radiopharmaceuticals (addendum 2 to ICRP 53). Ann ICRP 28:1–126
86.
go back to reference Hurwitz LM, Yoshizumi T, Reiman RE et al (2006) Radiation dose to the fetus from body MDCT during early gestation. AJR Am J Roentgenol 186:871–876PubMed Hurwitz LM, Yoshizumi T, Reiman RE et al (2006) Radiation dose to the fetus from body MDCT during early gestation. AJR Am J Roentgenol 186:871–876PubMed
87.
go back to reference Bourjeily G, Khalil H, Raker C et al (2012) Outcomes of negative multidetector computed tomography with pulmonary angiography in pregnant women suspected of pulmonary embolism. Lung 190:105–111PubMed Bourjeily G, Khalil H, Raker C et al (2012) Outcomes of negative multidetector computed tomography with pulmonary angiography in pregnant women suspected of pulmonary embolism. Lung 190:105–111PubMed
88.
go back to reference Kuriakose J, Patel S (2010) Acute pulmonary embolism. Radiol Clin North Am 48:31–50PubMed Kuriakose J, Patel S (2010) Acute pulmonary embolism. Radiol Clin North Am 48:31–50PubMed
89.
go back to reference The task force for the diagnosis and managment of acute pulmonary embolism of the european society of cardiology (ESC) (2008) Guidelines on the diagnosis and management of acute pulmonary embolism. Eur Heart J 29:2276–2315 The task force for the diagnosis and managment of acute pulmonary embolism of the european society of cardiology (ESC) (2008) Guidelines on the diagnosis and management of acute pulmonary embolism. Eur Heart J 29:2276–2315
90.
go back to reference Doshi SK, Negus IS, Oduko JM (2008) Fetal radiation dose from CT pulmonary angiography in late pregnancy: phantom study. Br J Radiol 81:653–658PubMed Doshi SK, Negus IS, Oduko JM (2008) Fetal radiation dose from CT pulmonary angiography in late pregnancy: phantom study. Br J Radiol 81:653–658PubMed
91.
go back to reference Kennedy EV, Iball GR, Brettle DS (2007) Investigation into the effects of lead shielding for fetal dose reduction in CT pulmonary angiography. Br J Radiol 80(956):631–638PubMed Kennedy EV, Iball GR, Brettle DS (2007) Investigation into the effects of lead shielding for fetal dose reduction in CT pulmonary angiography. Br J Radiol 80(956):631–638PubMed
92.
go back to reference Gilet AG, Dunkin JM, Fernandez TJ, Button TM, Budorick NE (2011) Fetal radiation dose during gestation estimated on an anthropomorphic phantom for three generations of CT scanners. AJR Am J Roentgenol 196(5):1133–1137PubMed Gilet AG, Dunkin JM, Fernandez TJ, Button TM, Budorick NE (2011) Fetal radiation dose during gestation estimated on an anthropomorphic phantom for three generations of CT scanners. AJR Am J Roentgenol 196(5):1133–1137PubMed
93.
go back to reference Wang F, Fang W, Lv B et al (2009) Comparison of lung scintigraphy with multi-slice spiral computed tomography in the diagnosis of pulmonary embolism. Clin Nucl Med 34:424–427PubMed Wang F, Fang W, Lv B et al (2009) Comparison of lung scintigraphy with multi-slice spiral computed tomography in the diagnosis of pulmonary embolism. Clin Nucl Med 34:424–427PubMed
94.
go back to reference Winer-Muram HT, Boone JM, Brown HL et al (2002) Pulmonary embolism in pregnant patients: fetal radiation dose with helical CT. Radiology 224:487–492PubMed Winer-Muram HT, Boone JM, Brown HL et al (2002) Pulmonary embolism in pregnant patients: fetal radiation dose with helical CT. Radiology 224:487–492PubMed
95.
go back to reference Yousefzadeh DK, Ward MB, Reft C (2006) Internal barium shielding to minimize fetal irradiation in spiral chest CT: a phantom simulation experiment. Radiology 239:751–758PubMed Yousefzadeh DK, Ward MB, Reft C (2006) Internal barium shielding to minimize fetal irradiation in spiral chest CT: a phantom simulation experiment. Radiology 239:751–758PubMed
96.
go back to reference Kline JA, Courtney DM, Beam DM et al (2009) Incidence and predictors of repeated computed tomographic pulmonary angiography in emergency department patients. Ann Emerg Med 54:41–48PubMed Kline JA, Courtney DM, Beam DM et al (2009) Incidence and predictors of repeated computed tomographic pulmonary angiography in emergency department patients. Ann Emerg Med 54:41–48PubMed
97.
go back to reference Hochhegger B, Marchiori E, Zanetti G et al (2011) MR imaging in pulmonary embolism during pregnancy. Radiology 260:304–305PubMed Hochhegger B, Marchiori E, Zanetti G et al (2011) MR imaging in pulmonary embolism during pregnancy. Radiology 260:304–305PubMed
98.
go back to reference Fraser DGW, Moody AR, Morgan PS et al (2002) Diagnosis of lower-limb deep venous thrombosis: a prospective blinded study of magnetic resonance direct thrombus imaging. Ann Intern Med 136:89–98PubMed Fraser DGW, Moody AR, Morgan PS et al (2002) Diagnosis of lower-limb deep venous thrombosis: a prospective blinded study of magnetic resonance direct thrombus imaging. Ann Intern Med 136:89–98PubMed
99.
go back to reference Stein PD, Chenevert TL, Fowler SE et al (2010) PIOPED III (prospective investigation of pulmonary embolism diagnosis III) investigators. Gadolinium-enhanced magnetic resonance angiography for pulmonary embolism: a multicenter prospective study (PIOPED III). Ann Intern Med 152:434–443PubMedCentralPubMed Stein PD, Chenevert TL, Fowler SE et al (2010) PIOPED III (prospective investigation of pulmonary embolism diagnosis III) investigators. Gadolinium-enhanced magnetic resonance angiography for pulmonary embolism: a multicenter prospective study (PIOPED III). Ann Intern Med 152:434–443PubMedCentralPubMed
100.
go back to reference Katzberg RW, McGahan JP (2011) Science to practice: will Gadolinium-enhanced MR imaging be useful in assessment of at-risk pregnancies? Radiology 258:325–326PubMed Katzberg RW, McGahan JP (2011) Science to practice: will Gadolinium-enhanced MR imaging be useful in assessment of at-risk pregnancies? Radiology 258:325–326PubMed
101.
go back to reference Kluge A, Muller C, Hansel J et al (2004) Real-time MR with TrueFISP for the detection of acute pulmonary embolism: initial clinical experience. Eur Radiol 14:709–718PubMed Kluge A, Muller C, Hansel J et al (2004) Real-time MR with TrueFISP for the detection of acute pulmonary embolism: initial clinical experience. Eur Radiol 14:709–718PubMed
102.
go back to reference Kluge A, Luboldt W, Bachmann G (2006) Acute pulmonary embolism to the subsegmental level: diagnostic accuracy of three MRI techniques compared with 16-MDCT. AJR Am J Roentgenol 187:W7–W14PubMed Kluge A, Luboldt W, Bachmann G (2006) Acute pulmonary embolism to the subsegmental level: diagnostic accuracy of three MRI techniques compared with 16-MDCT. AJR Am J Roentgenol 187:W7–W14PubMed
103.
go back to reference Schneider D, Heilmann L, Harenberg J (1995) Placental transfer of low-molecular weight heparin. Geburtshilfe Frauenheilkd 55:93–98PubMed Schneider D, Heilmann L, Harenberg J (1995) Placental transfer of low-molecular weight heparin. Geburtshilfe Frauenheilkd 55:93–98PubMed
104.
go back to reference Montalescot G, Collet JP, Tanguy ML, Ankri A, Payot L, Dumaine R, Choussat R, Beygui F, Gallois V, Thomas D (2004) Anti-Xa activity relates to survival and efficacy in unselected acute coronary syndrome patients treated with enoxaparin. Circulation 110:392–398PubMed Montalescot G, Collet JP, Tanguy ML, Ankri A, Payot L, Dumaine R, Choussat R, Beygui F, Gallois V, Thomas D (2004) Anti-Xa activity relates to survival and efficacy in unselected acute coronary syndrome patients treated with enoxaparin. Circulation 110:392–398PubMed
105.
go back to reference Lebaudy C, Hulot JS, Amoura Z, Costedoat-Chalumeau N, Serreau R, Ankri A, Conard J, Cornet A, Dommergues M, Piette JC, Lechat P (2008) Changes in enoxaparin pharmacokinetics during pregnancy and implications for antithrombotic therapeutic strategy. Clin Pharmacol Ther 84:370–377PubMed Lebaudy C, Hulot JS, Amoura Z, Costedoat-Chalumeau N, Serreau R, Ankri A, Conard J, Cornet A, Dommergues M, Piette JC, Lechat P (2008) Changes in enoxaparin pharmacokinetics during pregnancy and implications for antithrombotic therapeutic strategy. Clin Pharmacol Ther 84:370–377PubMed
106.
go back to reference Greer IA, Nelson-Piercy C (2005) Low-molecularweight heparins for thromboprophylaxis and treatment of venous thromboembolism in pregnancy: a systematic review of safety and efficacy. Blood 106:401–407PubMed Greer IA, Nelson-Piercy C (2005) Low-molecularweight heparins for thromboprophylaxis and treatment of venous thromboembolism in pregnancy: a systematic review of safety and efficacy. Blood 106:401–407PubMed
107.
go back to reference Laurent P, Dussarat G-V, Bonal J et al (2002) Low molecular weight heparins: a guide to their optimum use in pregnancy. Drugs 62:463–477PubMed Laurent P, Dussarat G-V, Bonal J et al (2002) Low molecular weight heparins: a guide to their optimum use in pregnancy. Drugs 62:463–477PubMed
108.
go back to reference Pettila V, Leinonen P, Markkola A et al (2002) Postpartum bone mineral density in women treated for thromboprophylaxis with unfractionated heparin or LMW heparin. Thromb Haemost 87:182–186PubMed Pettila V, Leinonen P, Markkola A et al (2002) Postpartum bone mineral density in women treated for thromboprophylaxis with unfractionated heparin or LMW heparin. Thromb Haemost 87:182–186PubMed
109.
go back to reference European Society of Gynecology (ESG); Association for European Paediatric Cardiology (AEPC); German Society for Gender Medicine (DGesGM), Regitz-Zagrosek V, Blomstrom Lundqvist C, Borghi C, Cifkova R, Ferreira R, Foidart JM, Gibbs JS, Gohlke-Baerwolf C, Gorenek B, Iung B, Kirby M, Maas AH, Morais J, Nihoyannopoulos P, Pieper PG, Presbitero P, Roos-Hesselink JW, Schaufelberger M, Seeland U, Torracca L, ESC Committee for Practice Guidelines (2011) ESC Guidelines on the management of cardiovascular diseases during pregnancy: the Task Force on the Management of Cardiovascular Diseases during Pregnancy of the European Society of Cardiology (ESC). Eur Heart J 32(24):3147–3197. doi:10.1093/eurheartj/ehr218 PubMed European Society of Gynecology (ESG); Association for European Paediatric Cardiology (AEPC); German Society for Gender Medicine (DGesGM), Regitz-Zagrosek V, Blomstrom Lundqvist C, Borghi C, Cifkova R, Ferreira R, Foidart JM, Gibbs JS, Gohlke-Baerwolf C, Gorenek B, Iung B, Kirby M, Maas AH, Morais J, Nihoyannopoulos P, Pieper PG, Presbitero P, Roos-Hesselink JW, Schaufelberger M, Seeland U, Torracca L, ESC Committee for Practice Guidelines (2011) ESC Guidelines on the management of cardiovascular diseases during pregnancy: the Task Force on the Management of Cardiovascular Diseases during Pregnancy of the European Society of Cardiology (ESC). Eur Heart J 32(24):3147–3197. doi:10.​1093/​eurheartj/​ehr218 PubMed
111.
go back to reference Narin C, Reyhanoglu H, Tülek B, Onoglu R, Ege E, Sarigül A, Yeniterzi M, Durmaz I (2008) Comparison of different dose regimens of enoxaparin in deep vein thrombosis therapy in pregnancy. Adv Ther 25(6):585–594. doi:10.1007/s12325-008-0068-0 PubMed Narin C, Reyhanoglu H, Tülek B, Onoglu R, Ege E, Sarigül A, Yeniterzi M, Durmaz I (2008) Comparison of different dose regimens of enoxaparin in deep vein thrombosis therapy in pregnancy. Adv Ther 25(6):585–594. doi:10.​1007/​s12325-008-0068-0 PubMed
112.
go back to reference McLintock C, Brighton T, Chunilal S, Dekker G, McDonnell N, McRae S, Muller P, Tran H, Walters BN, Young L, Councils of the Society of Obstetric Medicine of Australia and New Zealand, Australasian Society of Thrombosis and Haemostasis (2012) Recommendations for the diagnosis and treatment of deep venous thrombosis and pulmonary embolism in pregnancy and the postpartum period. Aust N Z J Obstet Gynaecol 52(1):14–22. doi:10.1111/j.1479-828X.2011.01361.x PubMed McLintock C, Brighton T, Chunilal S, Dekker G, McDonnell N, McRae S, Muller P, Tran H, Walters BN, Young L, Councils of the Society of Obstetric Medicine of Australia and New Zealand, Australasian Society of Thrombosis and Haemostasis (2012) Recommendations for the diagnosis and treatment of deep venous thrombosis and pulmonary embolism in pregnancy and the postpartum period. Aust N Z J Obstet Gynaecol 52(1):14–22. doi:10.​1111/​j.​1479-828X.​2011.​01361.​x PubMed
113.
go back to reference Ginsberg JS, Kowalchuk G, Hirsh J et al (1989) Heparin therapy during pregnancy: risks to the fetus and mother. Arch Intern Med 149:2233–2236PubMed Ginsberg JS, Kowalchuk G, Hirsh J et al (1989) Heparin therapy during pregnancy: risks to the fetus and mother. Arch Intern Med 149:2233–2236PubMed
114.
go back to reference Muir J, Andrew M, Hirsh J et al (1996) Histomorphometric analysis of the effect of standard heparin on trabecular bone in vivo. Blood 88:1314–1320PubMed Muir J, Andrew M, Hirsh J et al (1996) Histomorphometric analysis of the effect of standard heparin on trabecular bone in vivo. Blood 88:1314–1320PubMed
115.
go back to reference Dahlman TC (1993) Osteoporotic fractures and the recurrence of thromboembolism during pregnancy and the puerperium in184 women undergoing thrombo-prophylaxis with heparin. Am J Obstet Gynecol 168:1265–1270PubMed Dahlman TC (1993) Osteoporotic fractures and the recurrence of thromboembolism during pregnancy and the puerperium in184 women undergoing thrombo-prophylaxis with heparin. Am J Obstet Gynecol 168:1265–1270PubMed
116.
go back to reference Linkins LA, Dans AL, Moores LK et al (2012) American College of Chest Physicians. Treatment and prevention of heparin-induced thrombocytopenia: antithrombotic therapy and prevention of thrombosis, 9th ed: American College of Chest Physicians evidence-based clinical practice guidelines. Chest 141:e495S–e530SPubMedCentralPubMed Linkins LA, Dans AL, Moores LK et al (2012) American College of Chest Physicians. Treatment and prevention of heparin-induced thrombocytopenia: antithrombotic therapy and prevention of thrombosis, 9th ed: American College of Chest Physicians evidence-based clinical practice guidelines. Chest 141:e495S–e530SPubMedCentralPubMed
117.
go back to reference Girolami B, Prandoni P, Stefani PM et al (2003) The incidence of heparin-induced thrombocytopenia in hospitalized medical patients treated with subcutaneous unfractionated heparin: a prospective cohort study. Blood 101:2955–2959 Girolami B, Prandoni P, Stefani PM et al (2003) The incidence of heparin-induced thrombocytopenia in hospitalized medical patients treated with subcutaneous unfractionated heparin: a prospective cohort study. Blood 101:2955–2959
118.
go back to reference Junqueira DR, Perini E, Penholati RR et al (2012) Unfractionated heparin versus low molecular weight heparin for avoiding heparin-induced thrombocytopenia in postoperative patients. Cochrane Database Syst Rev 9:CD007557. doi:10.1002/14651858.CD007557.pub2 PubMed Junqueira DR, Perini E, Penholati RR et al (2012) Unfractionated heparin versus low molecular weight heparin for avoiding heparin-induced thrombocytopenia in postoperative patients. Cochrane Database Syst Rev 9:CD007557. doi:10.​1002/​14651858.​CD007557.​pub2 PubMed
119.
go back to reference Ajayi AA, Pharmacols FB, Cooper J, Horn EH, Rubin PC (2007) Comparison of the effects of unfractionated heparin and the low-molecular-weight heparins dalteparin and enoxaparin on spontaneous platelet aggregation and adenosine diphosphate activity in platelets during the third trimester of pregnancy. Methods Find Exp Clin Pharmacol 29(8):539–545PubMed Ajayi AA, Pharmacols FB, Cooper J, Horn EH, Rubin PC (2007) Comparison of the effects of unfractionated heparin and the low-molecular-weight heparins dalteparin and enoxaparin on spontaneous platelet aggregation and adenosine diphosphate activity in platelets during the third trimester of pregnancy. Methods Find Exp Clin Pharmacol 29(8):539–545PubMed
121.
go back to reference Chan WS, Anand S, Ginsberg JS (2000) Anticoagulation of pregnant women with mechanical heart valves: a systematic review of the literature. Arch Intern Med 160:191–196PubMed Chan WS, Anand S, Ginsberg JS (2000) Anticoagulation of pregnant women with mechanical heart valves: a systematic review of the literature. Arch Intern Med 160:191–196PubMed
122.
go back to reference Nassar AH, Hobeika EM, Abd Essamad HM et al (2004) Pregnancy outcome in women with prosthetic heart valves. Am J Obstet Gynecol 191:1009–1013PubMed Nassar AH, Hobeika EM, Abd Essamad HM et al (2004) Pregnancy outcome in women with prosthetic heart valves. Am J Obstet Gynecol 191:1009–1013PubMed
123.
go back to reference Schaefer C, Hannemann D, Meister R et al (2006) Vitamin K antagonists and pregnancy outcome. A multi-centre prospective study. Thromb Haemost 95:949–957PubMed Schaefer C, Hannemann D, Meister R et al (2006) Vitamin K antagonists and pregnancy outcome. A multi-centre prospective study. Thromb Haemost 95:949–957PubMed
124.
go back to reference Meschengieser SS, Fondevila CG, Santarelli MT et al (1999) Anticoagulation in pregnant women withmechanical heart valve prostheses. Heart 82:23–26PubMedCentralPubMed Meschengieser SS, Fondevila CG, Santarelli MT et al (1999) Anticoagulation in pregnant women withmechanical heart valve prostheses. Heart 82:23–26PubMedCentralPubMed
125.
go back to reference Branch DW, Khamashta MA (2003) Antiphospholipid syndrome: obstetric diagnosis, management, and controversies. Obstet Gynecol 101:1333–1344PubMed Branch DW, Khamashta MA (2003) Antiphospholipid syndrome: obstetric diagnosis, management, and controversies. Obstet Gynecol 101:1333–1344PubMed
126.
go back to reference Wesseling J, Van Driel D, Heymans HS et al (2001) Coumarins during pregnancy: long-term effects on growth and development of school-age children. Thromb Haemost 85:609–613PubMed Wesseling J, Van Driel D, Heymans HS et al (2001) Coumarins during pregnancy: long-term effects on growth and development of school-age children. Thromb Haemost 85:609–613PubMed
127.
go back to reference Geelani MA, Singh S, Verma A et al (2005) Anticoagulation in patients with mechanical valves during pregnancy. Asian Cardiovasc Thorac Ann 13:30–33PubMed Geelani MA, Singh S, Verma A et al (2005) Anticoagulation in patients with mechanical valves during pregnancy. Asian Cardiovasc Thorac Ann 13:30–33PubMed
128.
go back to reference The American College of Obstetricians and Gynecologists Practice Bulletin (2011) Thromboembolism in Pregnancy. Obstetr Gynecol 118:718–729 The American College of Obstetricians and Gynecologists Practice Bulletin (2011) Thromboembolism in Pregnancy. Obstetr Gynecol 118:718–729
129.
go back to reference Gupta S, Ettles DF, Robinson GJ et al (2008) Inferior vena cava filter use in pregnancy: preliminary experience. BJOG 115:785–788PubMed Gupta S, Ettles DF, Robinson GJ et al (2008) Inferior vena cava filter use in pregnancy: preliminary experience. BJOG 115:785–788PubMed
130.
go back to reference Hague WM, North RA, Gallus AS, Walters BN, Orlikowski C, Burrows RF, Cincotta RB, Dekker GA, Higgins JR, Lowe SA, Morris JM, Peek MJ (2001) Working group of the obstetric medicine group of Australasia. Anticoagulation in pregnancy and the puerperium. Med J Aust 175(5):258–263PubMed Hague WM, North RA, Gallus AS, Walters BN, Orlikowski C, Burrows RF, Cincotta RB, Dekker GA, Higgins JR, Lowe SA, Morris JM, Peek MJ (2001) Working group of the obstetric medicine group of Australasia. Anticoagulation in pregnancy and the puerperium. Med J Aust 175(5):258–263PubMed
131.
go back to reference Horlocker TT, Wedel DJ, Rowlingson JC et al (2010) Executive summary: regional anesthesia in the patient receiving antithrombotic or thrombolytic therapy: American society of regional anesthesia and pain medicine evidence-based guidelines (Third Edition). Reg Anesth Pain Med 35:102–105PubMed Horlocker TT, Wedel DJ, Rowlingson JC et al (2010) Executive summary: regional anesthesia in the patient receiving antithrombotic or thrombolytic therapy: American society of regional anesthesia and pain medicine evidence-based guidelines (Third Edition). Reg Anesth Pain Med 35:102–105PubMed
132.
go back to reference James A (2011) Practice bulletin no. 123: thromboembolism in pregnancy. Obstet Gynecol 118:718–729PubMed James A (2011) Practice bulletin no. 123: thromboembolism in pregnancy. Obstet Gynecol 118:718–729PubMed
133.
go back to reference Ellison J, Thomson AJ, Conkie JA, McCall F, Walker D, Greer A (2001) Thromboprophylaxis following caesarean section—a comparison of the antithrombotic properties of three low molecular weight heparins: dalteparin, enoxaparin and tinzaparin. Thromb Haemost 86:1374–1378PubMed Ellison J, Thomson AJ, Conkie JA, McCall F, Walker D, Greer A (2001) Thromboprophylaxis following caesarean section—a comparison of the antithrombotic properties of three low molecular weight heparins: dalteparin, enoxaparin and tinzaparin. Thromb Haemost 86:1374–1378PubMed
134.
go back to reference Fareed J, Hoppensteadt D, Schultz C, Ma Q, Kujawski MF, Neville B et al (2004) Biochemical and pharmacologic heterogeneity in low molecular weight heparins. Impact on the therapeutic profile. Curr Pharm Des 10:983–999PubMed Fareed J, Hoppensteadt D, Schultz C, Ma Q, Kujawski MF, Neville B et al (2004) Biochemical and pharmacologic heterogeneity in low molecular weight heparins. Impact on the therapeutic profile. Curr Pharm Des 10:983–999PubMed
136.
go back to reference American Academy of Pediatrics Committee on Drugs (2001) Transfer of drugs and other chemicals into human milk. Pediatrics 108:776–789 American Academy of Pediatrics Committee on Drugs (2001) Transfer of drugs and other chemicals into human milk. Pediatrics 108:776–789
137.
go back to reference Holden EL, Ranu H, Sheth A et al (2011) Thrombolysis for massive pulmonary embolism in pregnancy–a report of three cases and follow up over a two year period. Thromb Res 127:58–59PubMed Holden EL, Ranu H, Sheth A et al (2011) Thrombolysis for massive pulmonary embolism in pregnancy–a report of three cases and follow up over a two year period. Thromb Res 127:58–59PubMed
138.
go back to reference Goldhaber SZ, Haire WD, Feldstein ML et al (1993) Alteplase versus heparin in acute pulmonary embolism:randomised trial assessing right-ventricular function and pulmonary perfusion. Lancet 341:507–511PubMed Goldhaber SZ, Haire WD, Feldstein ML et al (1993) Alteplase versus heparin in acute pulmonary embolism:randomised trial assessing right-ventricular function and pulmonary perfusion. Lancet 341:507–511PubMed
139.
go back to reference Taniguchi S, Fukuda I, Minakawa M, Watanabe K, Daitoku K, Suzuki Y (2008) Emergency pulmonary embolectomy during the second trimester of pregnancy: report of a case. Surg Today 38(1):59–61PubMed Taniguchi S, Fukuda I, Minakawa M, Watanabe K, Daitoku K, Suzuki Y (2008) Emergency pulmonary embolectomy during the second trimester of pregnancy: report of a case. Surg Today 38(1):59–61PubMed
140.
go back to reference Turrentine MA, Braems G, Ramirez MM (1995) Use of thrombolytics for the treatment of thromboembolic disease during pregnancy. Obstet Gynecol Surv 50:534–541PubMed Turrentine MA, Braems G, Ramirez MM (1995) Use of thrombolytics for the treatment of thromboembolic disease during pregnancy. Obstet Gynecol Surv 50:534–541PubMed
141.
go back to reference Leonhardt G, Gaul C, Nietsch HH et al (2006) Thrombolytic therapy in pregnancy. J Thromb Thrombolysis 21:271–276PubMed Leonhardt G, Gaul C, Nietsch HH et al (2006) Thrombolytic therapy in pregnancy. J Thromb Thrombolysis 21:271–276PubMed
142.
go back to reference Fasullo S, Maringhini G, Terrazzino G et al (2011) Thrombolysis for massive pulmonary embolism in pregnancy: a case report. Int J Emerg Med 4:69–74PubMedCentralPubMed Fasullo S, Maringhini G, Terrazzino G et al (2011) Thrombolysis for massive pulmonary embolism in pregnancy: a case report. Int J Emerg Med 4:69–74PubMedCentralPubMed
144.
go back to reference Erkut B, Kocak H, Becit N et al (2006) Massive pulmonary embolism complicated by a patent foramen ovale with straddling thrombus: report of a case. Surg Today 36:528–533PubMed Erkut B, Kocak H, Becit N et al (2006) Massive pulmonary embolism complicated by a patent foramen ovale with straddling thrombus: report of a case. Surg Today 36:528–533PubMed
145.
go back to reference Becker RM (1983) Intracardiac surgery in pregnant women. Ann Thorac Surg 36:453–458PubMed Becker RM (1983) Intracardiac surgery in pregnant women. Ann Thorac Surg 36:453–458PubMed
146.
go back to reference Hajj-Chahine J, Jayle C, Tomasi J et al (2010) Successful surgical management of massive pulmonary embolism during the second trimester in a parturient with heparin-induced thrombocytopenia. Interact Cardiovasc Thorac Surg 11:679–681PubMed Hajj-Chahine J, Jayle C, Tomasi J et al (2010) Successful surgical management of massive pulmonary embolism during the second trimester in a parturient with heparin-induced thrombocytopenia. Interact Cardiovasc Thorac Surg 11:679–681PubMed
147.
go back to reference Lonjaret L, Lairez O, Galinier M et al (2010) Thrombolysis by recombinant tissue plasminogen activator during pregnancy: a case of massivepulmonary embolism. Am J Emerg Med 2011(29):e1–e2 Lonjaret L, Lairez O, Galinier M et al (2010) Thrombolysis by recombinant tissue plasminogen activator during pregnancy: a case of massivepulmonary embolism. Am J Emerg Med 2011(29):e1–e2
148.
go back to reference Liu Y, Sun Y, Zhang S, Jin X (2012) Placement of a retrievable inferior vena cava filter for deep venous thrombosis in term pregnancy. J Vasc Surg 55(4):1042–1047PubMed Liu Y, Sun Y, Zhang S, Jin X (2012) Placement of a retrievable inferior vena cava filter for deep venous thrombosis in term pregnancy. J Vasc Surg 55(4):1042–1047PubMed
149.
go back to reference Kawamata K, Chiba Y, Tanaka R et al (2005) Experience of temporary inferior vena cava filters inserted in the perinatal period to prevent pulmonary embolism in pregnant women with deep vein thrombosis. J Vasc Surg 41:27652–27656 Kawamata K, Chiba Y, Tanaka R et al (2005) Experience of temporary inferior vena cava filters inserted in the perinatal period to prevent pulmonary embolism in pregnant women with deep vein thrombosis. J Vasc Surg 41:27652–27656
150.
go back to reference van Roeters Lennep JE, Meijer E, Klumper FJ et al (2011) Prophylaxis with low-dose low-molecularweight heparin during pregnancy and postpartum: is it effective? J Thromb Haemost 9:473–480 van Roeters Lennep JE, Meijer E, Klumper FJ et al (2011) Prophylaxis with low-dose low-molecularweight heparin during pregnancy and postpartum: is it effective? J Thromb Haemost 9:473–480
151.
go back to reference Raţiu A, Motoc A, Păscuţ D, Crişan DC, Anca T, Păscuţ M (2009) Compression and walking compared with bed rest in the treatment of proximal deep venous thrombosis during pregnancy. Rev Med Chir Soc Med Nat Iasi 113(3):795–798PubMed Raţiu A, Motoc A, Păscuţ D, Crişan DC, Anca T, Păscuţ M (2009) Compression and walking compared with bed rest in the treatment of proximal deep venous thrombosis during pregnancy. Rev Med Chir Soc Med Nat Iasi 113(3):795–798PubMed
152.
153.
go back to reference Joung S, Robinson B (2002) Venous thromboembolism in cancer patients in Christchurch, 1995–1999. N Z Med J 115:257–260PubMed Joung S, Robinson B (2002) Venous thromboembolism in cancer patients in Christchurch, 1995–1999. N Z Med J 115:257–260PubMed
Metadata
Title
Pulmonary embolism in pregnancy
Authors
E. Conti
L. Zezza
E. Ralli
C. Comito
L. Sada
J. Passerini
D. Caserta
S. Rubattu
C. Autore
M. Moscarini
M. Volpe
Publication date
01-04-2014
Publisher
Springer US
Published in
Journal of Thrombosis and Thrombolysis / Issue 3/2014
Print ISSN: 0929-5305
Electronic ISSN: 1573-742X
DOI
https://doi.org/10.1007/s11239-013-0941-9

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