Am J Respir Crit Care Med. 2011 Nov 15;184(10):1200-8. doi: 10.1164/rccm.201108-1575ST.
Pulmonary embolism (PE) is a leading cause of maternal mortality in the developed world. Along with appropriate prophylaxis and therapy, prevention of death from PE in pregnancy requires a high index of clinical suspicion followed by a timely and accurate diagnostic approach.
To provide guidance on this important health issue, a multidisciplinary panel of major medical stakeholders was convened to develop evidence-based guidelines for evaluation of suspected pulmonary embolism in pregnancy using the Grades of Recommendation, Assessment, Development, and Evaluation (GRADE) system. In formulation of the recommended diagnostic algorithm, the important outcomes were defined to be diagnostic accuracy and diagnostic yield; the panel placed a high value on minimizing cumulative radiation dose when determining the recommended sequence of tests.
Overall, the quality of the underlying evidence for all recommendations was rated as very low or low, with some of the evidence considered for recommendations extrapolated from studies of the general population. Despite the low-quality evidence, strong recommendations were made for three specific scenarios: performance of chest radiography (CXR) as the first radiation-associated procedure; use of lung scintigraphy as the preferred test in the setting of a normal CXR; and performance of computed-tomographic pulmonary angiography (CTPA) rather than digital subtraction angiography (DSA) in a pregnant woman with a nondiagnostic ventilation-perfusion (V/Q) result.
The recommendations presented in this guideline are based upon the currently available evidence; availability of new clinical research data and development and dissemination of new technologies will necessitate a revision and update.
肺栓塞（PE）是发达国家孕产妇死亡的主要原因。除了适当的预防和治疗外，妊娠中预防 PE 导致的死亡还需要高度的临床怀疑，随后进行及时和准确的诊断方法。
为了解决这个重要的健康问题，召集了一个由主要医疗利益相关者组成的多学科小组，使用推荐分级的评估、制定与评价（GRADE）系统为妊娠疑似肺栓塞的评估制定基于证据的指南。在制定推荐的诊断算法时，重要的结果定义为诊断准确性和诊断产量；该小组在确定推荐的测试顺序时非常重视最小化累积辐射剂量。
总体而言，所有建议的基础证据质量均被评为极低或低，一些用于建议的证据是从一般人群的研究中推断出来的。尽管证据质量较低，但对三种特定情况提出了强烈的建议：进行胸部 X 光（CXR）作为第一个与辐射相关的程序；在 CXR 正常的情况下使用肺闪烁扫描作为首选测试；在通气灌注（V/Q）结果不明确的孕妇中进行计算机断层肺动脉造影（CTPA）而不是数字减影血管造影（DSA）。
本指南中提出的建议是基于目前现有的证据；新的临床研究数据的可用性以及新技术的开发和传播将需要进行修订和更新。
