Written by Shannon Markus
Spoon Feed
This review outlines updated evidence and international guidelines for diagnosing and managing suspected pulmonary embolism (PE) in pregnancy.
Breathe easy: Assessing PE in pregnancy, summarized
Here is the latest evidence on diagnosing and managing suspected PE during pregnancy.
- Chest X-ray: CXR is recommended as the initial imaging study in pregnant patients with dyspnea to look for alternative pathologies such as consolidation or pneumothorax.
- Risk Stratification: Both the Revised Geneva Score and the Pregnancy-Adapted YEARS Algorithm have been found to be safe and effective for diagnosing PE in pregnancy.
- Imaging Safety: Both ventilation-perfusion (V/Q) scanning and CT pulmonary angiography (CTPA) are considered safe and effective, and guidelines don’t favor one modality over the other.
- CTPA in pregnant patients: Advances in CT protocols reduce fetal radiation exposure up to 83% while maintaining accuracy. Regarding contrast, recent studies show no cases of neonatal hypothyroidism among infants exposed to contrast in utero.
- V/Q scan in pregnant patients: Perfusion-only scintigraphy (doing only the “Q” part of the V/Q) is becoming more common, which minimizes radiation for both mom and baby. Shielding is no longer recommended due to potential increases in fetal dose and image degradation.
Guidelines emphasize that diagnostic imaging should not be withheld when indicated by recommended algorithms, as empiric anticoagulation is not recommended due to associated risks. Counseling is essential to address patient anxiety about fetal radiation exposure and to reduce imaging refusal, particularly in the ED. Most academic societies now recommend imaging choice guided by both CXR results and also availability of CTPA vs. V/Q.
How does this affect my practice?
I welcome any peer-reviewed guideline, as I’ve often felt caught between a rock and a hard place when evaluating these vulnerable patients—balancing the risk of missing a diagnosis against the potential harms of radiation exposure. The authors acknowledge this diagnostic dilemma and the challenge of overlapping symptoms between pregnancy and PE, encouraging us to rely on validated decision-making tools and allaying fears about the safety of diagnostic imaging. I’ll breathe a little easier ordering a PE study on a pregnant patient who falls out of the low-risk category, knowing these updated guidelines support an evidence-based approach that balances the risks and benefits of working up these patients for PE.
Another Spoonful
Try our new JournalFeed PE Workup Calculator that walks you step by step through the evidence-based workup. You can toggle on/off whether the patient is pregnant. It’s also on our iPhone app.
Source
Diagnosing Pulmonary Embolism During Pregnancy. Chest. 2025 Oct;168(4):1007-1017. doi: 10.1016/j.chest.2025.05.014. Epub 2025 May 20. PMID: 40404047.
