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Pulmonary Embolism in Pregnancy

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  1. See Also
    1. Amniotic Fluid Embolism
    2. Pulmonary Embolism
    3. Deep Vein Thrombosis in Pregnancy
    4. Deep Vein Thrombosis
  2. Epidemiology
    1. Two thirds of pregnancy-related PE occur postpartum
  3. Symptoms and signs
    1. See Pulmonary Embolism
    2. Dyspnea
    3. Tachypnea
    4. Chest Pain may be present
    5. Unilateral leg signs of DVT in Pregnancy may be present
  4. Diagnostics
    1. Arterial Blood Gas
      1. A-a Gradient >20 mmHg
      2. PaO2 <85 mmHg
        1. When >28 weeks, may drops when supine by 15 mmHg
    2. Electrocardiogram (EKG)
      1. See EKG in Pulmonary Embolism
  5. Radiology
    1. Chest XRay
    2. Other diagnostic imaging based on evaluation below
  6. Evaluation
    1. See Pulmonary Embolism Diagnosis
    2. Some still favor VQ Scan over spiral CT angiogram
      1. Concern for spiral CT missing subsegmental defects
  7. Management
    1. See Pulmonary Embolism Management
    2. ABC Management
      1. Oxygen supplementation
      2. Cardiopulmonary stabilization
    3. Anticoagulation
      1. See Anticoagulation in Thromboembolism
      2. Heparin until delivery
        1. Unfractionated Heparin (weight-based) infusion or
        2. Low Molecular Weight Heparin
          1. Convert to infusion 24 hours before epidural
      3. Coumadin (do not use in pregnancy)
        1. Contraindicated in pregnancy
        2. May be used in Lactation
  8. Prevention
    1. See DVT in Pregnancy for prophylaxis

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