Objective: Interest in pulmonary embolism (PE) has undergone a renaissance since the emergence of COVID-19 pandemic, but PE researches among pregnant mothers in this post-COVID-19 era remains scarce. This study was conducted to (a) determine PE prevalence rate among pregnant and post-partum women with suspected PE after the COVID 19 pandemic, (b) compare the clinical characteristics, laboratory findings and CT features between the PE and non-PE cohorts, and (c) validate the Pregnancy-Adapted Geneva (PAG) score in our population.
Methods: This retrospective cross-sectional study involved the review of all maternal cases with suspected PE who underwent diagnostic CTPA in year 2022.
Results: A total of 120 patients represented by 90 pregnant patients and 30 post-partum patients were included in the analysis. The prevalence rate of PE was 22.5% (27/120) and gestational diabetes mellitus prevalence rate was significantly higher (48.1% vs. 26.9%; p = 0.037) in PE cohort. Besides, the proportion of patients with moderately and extremely raised peak D-dimer levels were significantly higher among the PE cohort. In patients with PE, the position of the most proximal clot was identified as subsegmental (n = 6, 22.2%) and segmental (n = 21; 77.8%). The predicted PE risk based on PAG score demonstrated poor calibration with the observed PE risk across all three groups, namely low-risk group (2.3% vs. 15.4%), intermediate-risk group (11.6% vs. 26.3%) and high-risk groups (61.5% vs. 0.0%).
Conclusion: Overall, PE among pregnant and post-partum populations remain a convoluted disease without distinctive clinical features. There is a need for a prospectively validated PE risk scores to guide its clinical diagnostic pathway.
WHAT IS ALREADY KNOWN ABOUT THAT TOPIC?: Pregnancy and post-partum women have a heightened risk of developing venous thromboembolic disease due to pregnancy associated physiological changes. All published studies concede that PE in pregnancy is a convoluted disease as it lacked of discriminative clinical and biochemical features. Hitherto, utilization of PE risk score or clinical gestalt have been guiding the decision of diagnostic work-up for PE among this population. WHAT THE ARTICLE ADDS TO THE LITERATURE?: This article informed about the high diagnostic yield of PE among pregnant and post-partum women in this study which was conducted during the post-COVID-19 era. Moreover, external validation of Pregnancy-Adapted Geneva score showed poor calibration between predicted risk and observed risk in our cohorts. Further studies are needed to investigate the incidence rate of PE in this post-COVID-19 era, and also to explore the clinician’s attitude in managing maternal cases with suspected PE. Lastly, incorporation of point of care ultrasound parameters in the PE risk score should be explored in future study in view of the limited value of clinical features as well as laboratory test in identifying PE among pregnant and post-partum mothers.
Keywords: Computed tomography pulmonary angiogram; Post-COVID-19 era; Pregnancy; Puerperium; Pulmonary embolism.
© 2025. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.
Keywords：Pulmonary Embolism; pregnancy; Puerperium; Post-COVID-19 Era
