Tromeur Cécile, van der Pol Liselotte M, Klok Frederikus A, Couturaud Francis, Huisman Menno V
Department of Thrombosis and Hemostasis, Leiden University Medical Center, Leiden, The Netherlands; Groupe d'Etude de la Thrombose de Bretagne Occidentale, Equipe d'Accueil 3878, Department of Internal Medicine and Chest Diseases, Brest, France; Centre d'Investigation Clinique INSERM 1412, Groupe d'Investigation et de Recherche Clinique, Brittany University of Brest, Brest, France.
Department of Thrombosis and Hemostasis, Leiden University Medical Center, Leiden, The Netherlands.
Thromb Res. 2017 Mar;151 Suppl 1:S86-S91. doi: 10.1016/S0049-3848(17)30075-0.
Women are at increased risk of venous thromboembolism (VTE) during pregnancy and VTE remains one of the main causes of maternal mortality in developed countries (Konstantinides SV, et al. Eur Heart J 2014; 35(43):3033-69, 69a-69k). Although an accurate diagnosis of acute pulmonary embolism (PE) in pregnant patients is thus of crucial importance, the diagnostic management of suspected PE is challenging for this specific patient category. As D-dimer levels increase physiologically throughout pregnancy, the optimal D-dimer threshold to rule out PE during pregnancy remains unknown. Available clinical decision rules, such as the Wells score and the revised Geneva rule, have not been evaluated in pregnant patients. Also, although ventilation-perfusion (V-Q) lung scan and computed tomography pulmonary angiography (CTPA) can be used in the pregnant population, both modalities have disadvantages of radiation exposure to both mother and foetus. Because of these uncertainties, clinical guidelines provide contradicting recommendations with weak levels of evidence. In this review, we illustrate these dilemmas and provide practice recommendation for the diagnostic management of suspected PE in pregnancy using two real-life patient cases.
女性在孕期发生静脉血栓栓塞症（VTE）的风险会增加，在发达国家，VTE仍是孕产妇死亡的主要原因之一（康斯坦丁尼德斯SV等人，《欧洲心脏杂志》2014年；35(43):3033 - 69, 69a - 69k）。因此，准确诊断孕妇的急性肺栓塞（PE）至关重要，但对于这类特定患者群体，疑似PE的诊断管理具有挑战性。由于整个孕期D - 二聚体水平会生理性升高，孕期排除PE的最佳D - 二聚体阈值仍不明确。现有的临床决策规则，如Wells评分和修订后的日内瓦规则，尚未在孕妇中进行评估。此外，尽管通气 - 灌注（V - Q）肺扫描和计算机断层扫描肺动脉造影（CTPA）可用于孕妇群体，但这两种检查方式都存在对母亲和胎儿辐射暴露的缺点。由于这些不确定性，临床指南给出了相互矛盾的建议，且证据水平薄弱。在本综述中，我们通过两个真实病例阐述这些困境，并为孕期疑似PE的诊断管理提供实践建议。
