Dr Inger Olesen1, Dr Darryl Shnier2, Mr Jason Heidrich2, Ms Thanh Nhi Nguyen2, Dr Briony Cutts1
1Department of Obstetric Medicine, Joan Kirner Womens' and Childrens' At Sunshine Hospital, Western Health, Melbourne, Australia, 2Department of Medical Imaging, Sunshine Hospital, Western Health, Melbourne, Australia
Biography:
Dr Inger Olesen is a Medical Oncologist with an interest in Medication Quality and Safety and expertise in the treatment of Gynaecological cancers.
She is currently completing the SOMANZ Obstetric Medicine certificate in order to develop expertise in the management of cancers during pregnancy.
Abstract:
Introduction: Pulmonary embolism (PE) remains one of the three most common causes of maternal death in Australia. Diagnosis during pregnancy remains a challenge as symptoms and signs of PE can occur as part of the normal physiological changes of pregnancy. The YEARs study showed imaging could be reduced for PE in pregnancy using clinical presentation and D-dimer level cut-offs however its utility was limited in the last trimester. We undertook a retrospective audit of pregnant women that have been imaged for potential PE at Western Health and compared this to an age-matched cohort of non-pregnant women to determine if the difference in rates reached statistical significance.
Aim: To determine the positivity rate for PE in diagnostic imaging (CTPA, VQ) in pregnant women, and compare this to an age-matched non-pregnant population.
Methods: A retrospective audit was performed of all diagnostic imaging (VQ or CTPA) to identify PE in women of childbearing age (14-47 years old) through Western Health Medical Imaging (WHMI) since June 2011. Other data to be collected and analysed includes age, trimester, clinical presentation and biomarkers.
Results: Interim analysis of the first 260 (of n = 1000) consecutive cases in pregnant patients shows n = 18 positive results (n = 16 VQ / 2 CTPA) giving an overall 6.9% positivity rate. The average age is 31. The number of women imaged within each trimester is 1st = 16 /2nd = 75/3rd = 159 and 10 postpartum. We will have the full data set to present by October including a comparison to non-pregnant women within the same defined age bracket (n = 5000) who also underwent VQ or CTPA.
Conclusion: We will have required data by October to determine if there is a statistically significant difference in rates of pregnant versus non-pregnant women imaged for PE at Western Health.
Keywords
Venous thromboembolism, thrombosis, pregnancy, imaging
References
1. Determining the diagnostic value of three clinical criteria Wells’, YEARS and modified Geneva in pregnant women with suspected pulmonary thromboembolism, August 2022. American Journal of Cardiovascular Disease 12(4):240-246
2. Diagnostic Management of Pregnant Women with Suspected Pulmonary Embolism, 2022 Mar 16. Frontiers in Cardiovascular Medicine.2022; 9:851985
3. D-dimer to rule out venous thromboembolism during pregnancy: A systematic review and meta-analysis. J Thromb Haemost. 2021 Oct; 19(10): 2454-2467.