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miércoles, 20 de enero de 2016

Pulmonary Embolism In Pregnancy

Sanders S, Hussain A (2016, January 19). Pulmonary Embolism in Pregnancy. [NUEM Blog. Expert Peer Review by Courtney DM]. 
Retrieved from http://www.nuemblog.com/blog/pe-in-pregnancy/
Diagnosing a pulmonary embolism (PE) in a pregnant patient is a situation that requires clinicians to employ a high index of suspicion. According to the Centers for Disease Control and Prevention (CDC), PE in pregnancy accounts for 20% of maternal deaths in the United States. The presentation is complicated by the fact that symptoms commonly associated with PE in the non-pregnant population can be caused by normal physiologic changes of pregnancy.
A recent study by Gherman et al reviewed the most common presenting symptoms of PE. These included dyspnea (62%), pleuritic chest pain (55%), cough (24%), and sweating (18%). However, Cahill and colleagues analyzed the association of common clinical presentations (chest pain, shortness of breath, O2 <95%, tachycardia, increased A-a gradient, and PaO2 <65mmHg) and the clinical suspicion of pulmonary embolism, and found no statistically significant association of any clinical feature, or grouping of features, that was associated with the confirmed presence of PE. Thus, symptomatology is non-specific in the approach of working up a suspected pulmonary embolism in pregnancy. The clinicians’ clinical judgment is key to starting down the road of investigation."
Adapted from Figure 1 of the American Thoracic Society Guidelines (4).