Chan W S, Ray J G, Murray S, Coady G E, Coates G, Ginsberg J S
Department of Medicine, Women's College Campus, Sunnybrook and Women's College Health Sciences Centre, 76 Grenville St, Toronto, Ontario, Canada M5S 1B2.
Arch Intern Med. 2002 May 27;162(10):1170-5. doi: 10.1001/archinte.162.10.1170.
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.
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.
The study group comprised 120 consecutive pregnant women who presented with suspected PE. Clinical data were collected, and the lung scans were reinterpreted by 2 independent experts. Subsequent pregnancy and pediatric outcomes were determined by direct patient follow-up.
During the study period, 120 pregnant women (mean age, 32 years) underwent 121 VQ scans. Eight cases (6.6%) were already receiving treatment for venous thromboembolism prior to VQ scanning. In the remaining 113 scans, 83 (73.5%) were interpreted as normal, 28 (24.8%) as nondiagnostic, and 2 (1.8%) as high probability. In the 104 women who did not receive anticoagulation therapy following lung scanning (80 normal and 24 nondiagnostic), no venous thromboembolic events were reported (mean [range] length of follow-up, 20.6 [0.5-108] months). Examination of pediatric data from 110 live births (90.2%) (mean [range] age, 20.5 [0.5-100] months) revealed no increase in the rates of congenital and developmental anomalies.
The prevalence of high-probability VQ scans in pregnant women with suspected PE and probable PE is very low. Withholding anticoagulation in pregnant women with normal or nondiagnostic VQ scans is probably safe. In addition, pediatric risks from VQ scans are low. Large prospective studies are needed to evaluate diagnostic strategies for pregnant women with suspected PE.
当孕期怀疑有肺栓塞（PE）时，会采用通气-灌注（VQ）扫描；然而，肺扫描结果的分布情况以及VQ扫描的安全性从未得到研究。
研究肺扫描结果的分布情况、VQ扫描的安全性以及孕妇在正常或非诊断性扫描后停用抗凝治疗的安全性。
研究组包括120例连续出现疑似PE的孕妇。收集临床数据，并由2名独立专家重新解读肺扫描结果。通过直接随访患者来确定后续的妊娠和儿科结局。
在研究期间，120名孕妇（平均年龄32岁）接受了121次VQ扫描。8例（6.6%）在VQ扫描前已在接受静脉血栓栓塞治疗。在其余113次扫描中，83次（73.5%）被解读为正常，28次（24.8%）为非诊断性，2次（1.8%）为高概率。在肺扫描后未接受抗凝治疗的104名女性（80例正常和24例非诊断性）中，未报告静脉血栓栓塞事件（平均[范围]随访时长，20.6 [0.5 - 108]个月）。对110例活产（90.2%）（平均[范围]年龄，20.5 [0.5 - 100]个月）的儿科数据检查显示，先天性和发育异常的发生率没有增加。
疑似PE和可能PE的孕妇中VQ扫描高概率的患病率非常低。对VQ扫描正常或非诊断性的孕妇停用抗凝治疗可能是安全的。此外，VQ扫描对儿科的风险较低。需要进行大型前瞻性研究来评估疑似PE孕妇的诊断策略。
