Abstract
Diagnosis of acute PE in pregnant women with haemodynamic instability is following the general integrated risk-adapted diagnostic algorithm and starts with bedside echocardiography to assess RV function. If RV dysfunction is identified, a prompt and immediate reperfusion without further imaging should be initiated. Although pregnancy is listed as a relative contraindication of systemic thrombolysis, in pregnant women with acute PE and haemodynamic instability thrombolysis must be considered. In those cases, other treatment strategies as surgical embolectomy or catheter-directed low-dose thromboylysis or percutaneous thrombectomy should be taken into consideration as well. A multidisciplinary team with experience of PE management in pregnancy should be consulted to reach consensus on the best treatment approach.
Highlights
Venous thromboembolism (VTE) is considered globally as the third most frequent acute cardiovascular syndrome and is an umbrella term for the clinical entities of acute pulmonary embolism (PE) and deep vein thrombosis (DVT) [1]
An overall decreasing trend in PE-related mortality over the past two decades was observed in a recent analysis of vital registration data in Europe, more than 1% of all deaths in women aged 15–50 years are caused by PE [3, 4]
Data from the UK and Ireland demonstrated that thrombosis and thromboembolism were the most common causes of direct maternal death in the years 2013–2015 resulting in 1.13 deaths per 100,000 maternities [7]
Summary
Venous thromboembolism (VTE) is considered globally as the third most frequent acute cardiovascular syndrome and is an umbrella term for the clinical entities of acute pulmonary embolism (PE) and deep vein thrombosis (DVT) [1]. An overall decreasing trend in PE-related mortality over the past two decades was observed in a recent analysis of vital registration data in Europe, more than 1% of all deaths in women aged 15–50 years are caused by PE [3, 4]. Data from the UK and Ireland demonstrated that thrombosis and thromboembolism were the most common causes of direct maternal death in the years 2013–2015 resulting in 1.13 deaths per 100,000 maternities [7]. Based on current epidemiological data from Germany, PE-related deaths in hospitalized women accounted for almost 14% of all maternal deaths [8]
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