Pulmonary embolism in pregnancy

Published on May 22, 2010in The Lancet60.392
· DOI :10.1016/S0140-6736(10)60798-2
Chirag Patel13
Estimated H-index: 13
(Churchill Hospital),
C. Patel4
Estimated H-index: 4
(Churchill Hospital)
+ 0 AuthorsFergus V. Gleeson58
Estimated H-index: 58
(Churchill Hospital)
Sources
Abstract
1778 www.thelancet.com May 22, 2010 a unique means of collecting relevant maternal mortality data), the main contributor to maternal mortality is indirect causes in the UK, hypertensive disorders in the Netherlands, and haemorrhage in France. Although thromboembolism con stitutes an important issue in pregnancy, it is important to keep in mind the actual pattern of causes of maternal mortality, in order to prioritise prevention strategies.
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: In the triennium 2006-2008, 261 women in the UK died directly or indirectly related to pregnancy. The overall maternal mortality rate was 11.39 per 100,000 maternities. Direct deaths decreased from 6.24 per 100,000 maternities in 2003-2005 to 4.67 per 100,000 maternities in 2006–2008 (p = 0.02). This decline is predominantly due to the reduction in deaths from thromboembolism and, to a lesser extent, haemorrhage. For the first time there has been a reduction in the inequalities gap, with a sig...
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#2Eric A. P. Steegers (Erasmus University Medical Center)H-Index: 14
Last. J. van Roosmalen (VUmc: VU University Medical Center)H-Index: 19
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Objective To assess causes, trends and substandard care factors in maternal mortality in the Netherlands. Design Confidential enquiry into the causes of maternal mortality. Setting Nationwide in the Netherlands. Population 2,557,208 live births. Methods Data analysis of all maternal deaths in the period 1993-2005. Main outcome measures Maternal mortality. Results The overall maternal mortality ratio was 12.1 per 100 000 live births, which was a statistically significant rise compared with the ma...
246 CitationsSource
#1Ghada Bourjeily (Brown University)H-Index: 21
#2Michael J. Paidas (Yale University)H-Index: 43
Last. Marc A. Rodger (U of O: University of Ottawa)H-Index: 77
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Summary Pulmonary embolism (PE) is the leading cause of maternal mortality in the developed world. Mortality from PE in pregnancy might be related to challenges in targeting the right population for prevention, ensuring that diagnosis is suspected and adequately investigated, and initiating timely and best possible treatment of this disease. Pregnancy is an example of Virchow's triad: hypercoagulability, venous stasis, and vascular damage; together these factors lead to an increased incidence of...
301 CitationsSource
OBJECTIVE. The purpose of this study was to retrospectively compare the diagnostic adequacy of lung scintigraphy with that of pulmonary CT angiography (CTA) in the care of pregnant patients with suspected pulmonary embolism.MATERIALS AND METHODS. Patient characteristics, radiology report content, additional imaging performed, final diagnosis, and diagnostic adequacy were recorded for pregnant patients consecutively referred for lung scintigraphy or pulmonary CTA according to physician preference...
148 CitationsSource
#1Andrew Scarsbrook (St James's University Hospital)H-Index: 29
#2Kevin M. Bradley (Churchill Hospital)H-Index: 28
Last. Fergus V. Gleeson (Churchill Hospital)H-Index: 58
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Pulmonary embolism (PE) is a major preventable cause of maternal mortality during pregnancy and accurate diagnosis is essential. Computed tomography pulmonary angiography (CTPA) is a robust diagnostic test in non-pregnant patients with suspected PE. The potential latent carcinogenic effects of CTPA-related breast irradiation mandates careful use of this technique in young women. The aim of this study was to determine the efficacy of perfusion scintigraphy as the first line investigation in pregn...
79 CitationsSource
#1André BenbassaH-Index: 1
#2Marie-Hélène Bouvier-Colle (French Institute of Health and Medical Research)H-Index: 35
Last. Stéphane St-LégerH-Index: 1
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En France, la surveillance de la mortalite maternelle a debute en 1995 avec le premier « planperinatalite ».Un Comite national d’experts sur la mortalite maternelle (CNEMM) a ete mis en place afind’etudier, par enquete confidentielle, le taux de la mortalite maternelle, ses facteurs de risques etd’evitabilite. Le Comite a egalement pour mission d’edicter des recommandations auxprofessionnels concernes pour ameliorer la situation.En 2001, l’InVS qui a mission de surveiller l’etat de sante de la p...
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OBJECTIVE. The purpose of this study was to evaluate whether using a chest radiograph to triage patients being imaged for pulmonary embolism (PE) with pulmonary CT angiography (CTA) or ventilation-perfusion scintigraphy resulted in fewer indeterminate imaging results.CONCLUSION. Chest radiograph can be a valuable triage tool in deciding an appropriate technique for imaging PE, and can yield more definitive diagnoses.
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Objective To use data from the Centers for Disease Control and Prevention's (CDC) Pregnancy-Related Mortality Surveillance System to examine trends in pregnancy-related mortality and risk factors for pregnancy-related death. Methods In collaboration with ACOG and state health departments, the Pregnancy-Related Mortality Surveillance System has collected information on all deaths caused by pregnancy since 1979. Multiple data sources were used, including national death files, state health departme...
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#1Wee-Shian Chan (Women's College, Kolkata)H-Index: 30
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Last. Jeffrey S. GinsbergH-Index: 113
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Background Ventilation-perfusion (VQ) scanning is used when pulmonary embolism (PE) is suspected during pregnancy; however, the distribution of lung scan results and safety of VQ scanning have never been studied. Objective To study the distribution of lung scan results and safety of VQ scanning as well as the safety of withholding anticoagulation therapy following a normal or nondiagnostic scan in pregnant women. Methods The study group comprised 120 consecutive pregnant women who presented with...
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Radiation from imaging diagnostic had caused many detrimental effects to patients. Imaging diagnostic is the largest manmade source of radiation exposure. Dose- response models have aided the study of effects of radiation from imaging diagnostic. Certain imaging tools have caused more radiation hazard towards patients such as computed tomography. Non-ionizing radiation imaging modalities have represented safer alternative. Medical practitioners should adopt as low as reasonably achievable princi...
#1I.J. Laurence (RUH: Royal United Hospital)H-Index: 1
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The following article is intended to illustrate the place of scintigraphy and computed tomography pulmonary angiography (CTPA) in the investigation of acute PE in current practice, and to guide non-radionuclide radiologists and other medical professionals to the best test for patients. We share our early experiences with ventilation–perfusion (V/Q) single-photon-emission computed tomography (SPECT) including image acquisition and interpretation. A comparison of the two techniques is given, along...
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#1Helen E. Davies (University Hospital of Wales)H-Index: 23
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#### Summary points Since the 1970s, when computed tomography was introduced into clinical practice, the array of imaging tests that expose patients to radiation has vastly increased. This is a result of improved computed tomography techniques, advances in other techniques such as digital subtraction angiography, and the development of modalities such as positron emission tomography coregistered with computed tomography and single photon emission tomography coregistered with computed tomography....
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OBJECTIVE. The purpose of this study was to retrospectively compare the diagnostic adequacy of lung scintigraphy with that of pulmonary CT angiography (CTA) in the care of pregnant patients with suspected pulmonary embolism.MATERIALS AND METHODS. Patient characteristics, radiology report content, additional imaging performed, final diagnosis, and diagnostic adequacy were recorded for pregnant patients consecutively referred for lung scintigraphy or pulmonary CTA according to physician preference...
148 CitationsSource