Abstract:

Introduction. Pulmonary embolism is an important public health problem in both developing and industrially developed countries. Diagnosis and management of pulmonary embolism remain a challenge for the current obstetrics practice, due to pregnancy-associated symptoms, which are sometimes similar to those of venous thromboembolism. The gold standard for diagnosis is computed tomography (CT) pulmonary angiography/ ventilation perfusion scanning, which imply radiation exposure for mother and fetus. Administration of “blind” anticoagulant therapy in pregnant women may increase the risk of hemorrhagic complications. The major challenge in these cases is to decide when angiography is really needed. Several algorithms and scores are proposed to avoid imaging techniques in these patients. The objective of the study was to evaluate local practices regarding the diagnosis of venous thromboembolism in the department of Obstetrics and gynecology of Louis Dommergues Hospital, Trinity, Martinique, and to compare them with the existing international guidelines. Material and methods. Presentation of series of cases with suspicion of venous thromboembolism investigated in the Department of Obstetrics and Gynecology of “Louis Dommergues” Hospital, Trinity, Martinique. Results. Initial diagnostic testing (electrocardiogram, blood gases, D-dimers, troponine, NT-proBNP) was performed for all pregnant patients presenting clinical suspicion of PE. According to the original Geneva score, the majority of patients had a high risk of PE (> 8 points) – 4 (44.44%) and 3 (33.33%) – intermediate (5 – 8 points) and 2 (22.22%) – low-risk of PE (0 – 5 points). PE was confirmed by angio-TC in 2 patients (22.22%). Conclusions. Clinical suspicion of pulmonary thromboembolism should lead to imaging techniques as CT angiography or ventilation/perfusion scanning. Abnormal blood gases, D-dimers, NT-pro BNP or electrocardiogram are not sufficient to confirm nor to invalidate the diagnosis. Keywords: pulmonary embolism, venous thromboembolism, pregnancy, guidelines.

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