Pulmonary Thromboembolism in Pregnancy: A Case Report and Literature Review

Figures & data

Table 1 Paraclinical Studies Requested Upon Admission

Study	Results
Quantitative Troponin I	212.0 ng/L
Lactic acid	3.68 mmol/L
D-dimer	9.9 mg/L
Arterial gases	Arterial BE,11.0 mmol/L Arterial cHCO3, 13.0 mmol/L Arterial PCO2, 24.6 mmHg Arterial pH, 7.340 Arterial PO2, 65.2 mmHg Arterial SO2(c), 91.3

Figure 1 McGinn-White sign: Q-wave in DIII, and an inverted T-wave in derivative DIII.

Figure 2 Multiple opacification defects in the right and left branches of the pulmonary artery and segmental branches of both lower lobes.

Table 2 Summary of the Main Pro-Coagulant Changes That Occur During Pregnancy

Remain neutral: Factors I and V and protein C

Increased concentrations: Factors II, VII, VIII, IX, X, and vWF

Decreased concentration: Protein S

5-fold increase: Plasminogen inhibitor type 1 levels

Increase from the third quarter onwards in the levels of PAI-2

Increase of prothrombins F1 and F2

These changes do not disappear until after week 8 postpartum

Table 3 The Wells Scoring System

Findings	Points
Clinical signs of deep vein thrombosis	3.0
Pulmonary embolism as the main diagnostic suspicion	3.0
Heart rate > 100 bpm (beats per minute)	1.5
Immobilization in the last 3 days or surgery in the last 3 weeks	1.5
Previous diagnosis of deep vein thrombosis or pulmonary embolism	1.5
Hemoptysis	1.0
Cancer	1.0

Table 4 Summary of Estimated Fetal Exposure According to Type of Study

Unilateral venography (without protective shield)	3 mGy
Focused venography	< 0.5 mGy
Perfusion scintigraphy	< 0.12 mGy
Ventilation scintigraphy	< 0.35 mGy
CTPA	0.5 mGy
Chest X-ray	< 0.1 mGy

Figure 3 Diagnostic algorithm for patients with suspected hemodynamically stable pulmonary embolism.

Figure 4 Diagnostic algorithm for patients with suspected hemodynamically unstable pulmonary embolism.

Table 5 Characteristics of Anticoagulants

Anticoagulant	Crosses Placenta	Secreted by Breast Milk	Recommended During Pregnancy	Recommended During Breastfeeding
LMWH	No	Yes	Yes	Yes
UFH	No	Yes	Yes	Yes
Fondaparinux	Yes	Yes	No	Yes
VKA	Yes	Yes	No	Yes
DOAC	Yes	Yes	No	No

Abbreviations: LMWH, Low molecular weight heparin; UFH, Unfractionated heparin; VKA, Vitamin K antagonist; DOAC, Direct oral anticoagulant.