{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,19]],"date-time":"2026-02-19T07:36:47Z","timestamp":1771486607471,"version":"3.50.1"},"reference-count":45,"publisher":"Georg Thieme Verlag KG","issue":"S 01","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Am J Perinatol"],"published-print":{"date-parts":[[2024,5]]},"abstract":"<jats:p>Pulmonary embolism (PE) is a significant cause of obstetric morbidity and mortality. However, overdiagnosis related to excessive use of diagnostic testing is also associated with long-term major health issues, including impact on future pregnancies and subsequent health care. Accurate diagnosis of PE depends on the knowledge of prevalence of PE in the pregnant population, the a priori probability of a PE based on specific findings in a given patient, and understanding of the accuracy of computed tomography pulmonary angiography (CTPA), the dominant diagnostic modality employed for this diagnosis. Venous thromboembolism is widely considered to be more common in pregnancy. However, this term includes both deep venous thrombosis as well as PE. While the former appears to be more common, published data on the prevalence of PE in pregnancy show little or no increase relative to the general population. Given the published data on the sensitivity and specificity of CTPA, a positive reading is more likely to be a false positive unless the probability of a PE in a given patient is at least 5% (a 200-fold increase from baseline). Doubling the probability to 10% (a 400-fold increase) only improves the positive predictive value to approximately 67%. Strategies to refine the a priori probability of a PE in a given patient are detailed, including scoring systems and D-dimer measurements. A careful history and physical examination and thoughtful development of a differential diagnosis are key elements of clinical practice and should include both the likelihood of each possible diagnosis and the accuracy of diagnostic modalities. This approach should precede the application of a given algorithm. Such a structured approach can decrease utilization and limit false positive diagnoses without increasing morbidity or mortality.<\/jats:p><jats:p>\n            Key Points\n          <\/jats:p>","DOI":"10.1055\/a-2112-8049","type":"journal-article","created":{"date-parts":[[2023,6,19]],"date-time":"2023-06-19T23:24:00Z","timestamp":1687217040000},"page":"e2307-e2312","source":"Crossref","is-referenced-by-count":2,"special_numbering":"S","title":["Diagnosis of Pulmonary Embolism in Pregnancy"],"prefix":"10.1055","volume":"41","author":[{"given":"Jack","family":"Fitzsimmons","sequence":"additional","affiliation":[{"name":"Department of Obstetrics, Gynecology and Reproductive Sciences, Lewis Katz School of Medicine, Temple University, Philadelphia, Pennsylvania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Laura","family":"Hart","sequence":"additional","affiliation":[{"name":"Department of Obstetrics, Gynecology and Reproductive Sciences, Lewis Katz School of Medicine, Temple University, Philadelphia, Pennsylvania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Emily","family":"Oliver","sequence":"additional","affiliation":[{"name":"Department of Obstetrics, Gynecology and Reproductive Sciences, Lewis Katz School of Medicine, Temple University, Philadelphia, Pennsylvania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Wadia","family":"Mulla","sequence":"additional","affiliation":[{"name":"Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology and Reproductive Sciences, Lewis Katz School of Medicine, Temple University, Philadelphia, Pennsylvania"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"194","published-online":{"date-parts":[[2023,7,21]]},"reference":[{"issue":"05","key":"ref1","doi-asserted-by":"crossref","first-page":"362","DOI":"10.1016\/j.amjmed.2013.10.024","article-title":"Over-testing: why more is not better","volume":"127","author":"J Greenberg","year":"2014","journal-title":"Am J Med"},{"issue":"01","key":"ref2","doi-asserted-by":"crossref","first-page":"e005753","DOI":"10.1161\/CIRCOUTCOMES.119.005753","article-title":"Over-testing for suspected pulmonary embolism in American emergency departments: the continuing epidemic","volume":"13","author":"J A Kline","year":"2020","journal-title":"Circ Cardiovasc Qual Outcomes"},{"issue":"05","key":"ref3","doi-asserted-by":"crossref","first-page":"753","DOI":"10.3390\/healthcare10050753","article-title":"Use of computed tomography pulmonary angiography in emergency departments: a literature review","volume":"10","author":"L E Thurlow","year":"2022","journal-title":"Healthcare (Basel)"},{"issue":"06","key":"ref4","doi-asserted-by":"crossref","first-page":"622","DOI":"10.1016\/j.annemergmed.2011.04.014","article-title":"Rethinking testing for pulmonary embolism: less is more","volume":"57","author":"D H Newman","year":"2011","journal-title":"Ann Emerg Med"},{"issue":"01","key":"ref5","doi-asserted-by":"crossref","first-page":"6","DOI":"10.1080\/20009666.2018.1428024","article-title":"Computed tomography pulmonary angiography is overused to diagnose pulmonary embolism in the emergency department of academic community hospital","volume":"8","author":"M Osman","year":"2018","journal-title":"J Community Hosp Intern Med Perspect"},{"issue":"06","key":"ref6","doi-asserted-by":"crossref","first-page":"571","DOI":"10.1177\/1062860614543302","article-title":"CT pulmonary angiography utilization in the emergency department: diagnostic yield and adherence to current guidelines","volume":"30","author":"A Perelas","year":"2015","journal-title":"Am J Med Qual"},{"issue":"06","key":"ref7","doi-asserted-by":"crossref","first-page":"1202","DOI":"10.1016\/j.ejrad.2015.03.023","article-title":"Triage for suspected acute pulmonary embolism: think before opening Pandora's Box","volume":"84","author":"D Levin","year":"2015","journal-title":"Eur J Radiol"},{"issue":"22","key":"ref8","doi-asserted-by":"crossref","first-page":"2317","DOI":"10.1056\/NEJMoa052367","article-title":"Multidetector computed tomography for acute pulmonary embolism","volume":"354","author":"P D Stein","year":"2006","journal-title":"N Engl J Med"},{"issue":"05","key":"ref9","doi-asserted-by":"crossref","first-page":"561","DOI":"10.1016\/j.acra.2017.11.014","article-title":"A clinically meaningful interpretation of the prospective investigation of pulmonary embolism diagnosis (PIOPED) II and III data","volume":"25","author":"P Cronin","year":"2018","journal-title":"Acad Radiol"},{"key":"ref10","first-page":"478","volume-title":"Venous thrombosis and embolism","author":"J I Weitz","year":"2020"},{"key":"ref11","doi-asserted-by":"crossref","first-page":"1432759","DOI":"10.1155\/2019\/1432759","article-title":"Rate of non-diagnostic computerized tomography pulmonary angiograms (CTPAs) performed for diagnosis of pulmonary embolism in pregnant and immediately postpartum patients","volume":"2019","author":"S Hogan","year":"2019","journal-title":"Obstet Gynecol Int"},{"key":"ref12","first-page":"9","volume-title":"Biostatistics in Clinical Medicine","author":"J A Ingelfinger","year":"1983"},{"key":"ref13","first-page":"981","volume-title":"Williams Obstetrics. 26th ed","author":"Thromboembolic Disorders","year":"2022"},{"issue":"03","key":"ref14","first-page":"x","article-title":"Thrombosis, thrombosis, thrombophilia and thromboembolism. ACOG Clinical Update Women's","volume":"XV","author":"R Silver","year":"2016","journal-title":"Health Care (Don Mills)"},{"issue":"06","key":"ref15","doi-asserted-by":"crossref","first-page":"585","DOI":"10.1001\/archinte.158.6.585","article-title":"Trends in the incidence of deep vein thrombosis and pulmonary embolism: a 25-year population-based study","volume":"158","author":"M D Silverstein","year":"1998","journal-title":"Arch Intern Med"},{"issue":"04","key":"ref16","doi-asserted-by":"crossref","first-page":"611","DOI":"10.1016\/j.ccm.2010.07.001","article-title":"Epidemiology and incidence: the scope of the problem and risk factors for development of venous thromboembolism","volume":"31","author":"P D Stein","year":"2010","journal-title":"Clin Chest Med"},{"issue":"05","key":"ref17","doi-asserted-by":"crossref","first-page":"933","DOI":"10.1001\/archinte.1991.00400050081016","article-title":"A population-based perspective of the hospital incidence and case-fatality rates of deep vein thrombosis and pulmonary embolism. The Worcester DVT Study","volume":"151","author":"F A Anderson Jr","year":"1991","journal-title":"Arch Intern Med"},{"issue":"20","key":"ref18","doi-asserted-by":"crossref","first-page":"2260","DOI":"10.1001\/archinte.164.20.2260","article-title":"Venous thromboembolism according to age: the impact of an aging population","volume":"164","author":"P D Stein","year":"2004","journal-title":"Arch Intern Med"},{"issue":"04","key":"ref19","doi-asserted-by":"crossref","first-page":"692","DOI":"10.1111\/j.1538-7836.2007.02450.x","article-title":"Incidence and mortality of venous thrombosis: a population-based study","volume":"5","author":"I A Naess","year":"2007","journal-title":"J Thromb Haemost"},{"issue":"09","key":"ref20","doi-asserted-by":"crossref","first-page":"832.e13","DOI":"10.1016\/j.amjmed.2013.02.024","article-title":"Incidence of and mortality from venous thromboembolism in a real-world population: the Q-VTE study cohort","volume":"126","author":"V Tagalakis","year":"2013","journal-title":"Am J Med"},{"issue":"09","key":"ref21","doi-asserted-by":"crossref","first-page":"829","DOI":"10.1016\/j.amjmed.2014.03.041","article-title":"Secular trends in occurrence of acute venous thromboembolism: the Worcester VTE study (1985-2009)","volume":"127","author":"W Huang","year":"2014","journal-title":"Am J Med"},{"issue":"01","key":"ref22","doi-asserted-by":"crossref","first-page":"3","DOI":"10.1007\/s11239-015-1311-6","article-title":"The epidemiology of venous thromboembolism","volume":"41","author":"J A Heit","year":"2016","journal-title":"J Thromb Thrombolysis"},{"issue":"03","key":"ref23","doi-asserted-by":"crossref","first-page":"277","DOI":"10.1016\/S2213-2600(19)30354-6","article-title":"Trends in mortality related to pulmonary embolism in the European Region, 2000-15: analysis of vital registration data from the WHO mortality database","volume":"8","author":"S Barco","year":"2020","journal-title":"Lancet Respir Med"},{"key":"ref24","first-page":"730","article-title":"Incidence, clinical characteristics, and timing of objectively diagnosed venous thromboembolism during pregnancy","volume":"94","author":"R B Gherman","year":"1999","journal-title":"Obstet Gynecol"},{"issue":"10","key":"ref25","doi-asserted-by":"crossref","first-page":"697","DOI":"10.7326\/0003-4819-143-10-200511150-00006","article-title":"Trends in the incidence of venous thromboembolism during pregnancy or postpartum: a 30-year population-based study","volume":"143","author":"J A Heit","year":"2005","journal-title":"Ann Intern Med"},{"issue":"05","key":"ref26","doi-asserted-by":"crossref","first-page":"1311","DOI":"10.1016\/j.ajog.2005.11.008","article-title":"Venous thromboembolism during pregnancy and the postpartum period: incidence, risk factors, and mortality","volume":"194","author":"A H James","year":"2006","journal-title":"Am J Obstet Gynecol"},{"issue":"04","key":"ref27","doi-asserted-by":"crossref","first-page":"632","DOI":"10.1111\/j.1538-7836.2008.02921.x","article-title":"Pregnancy, the postpartum period and prothrombotic defects: risk of venous thrombosis in the MEGA study","volume":"6","author":"E R Pomp","year":"2008","journal-title":"J Thromb Haemost"},{"issue":"02","key":"ref28","doi-asserted-by":"crossref","first-page":"233.e1","DOI":"10.1016\/j.ajog.2007.08.041","article-title":"Incidence and risk patterns of venous thromboembolism in pregnancy and puerperium\u2013a register-based case-control study","volume":"198","author":"A F Jacobsen","year":"2008","journal-title":"Am J Obstet Gynecol"},{"issue":"01","key":"ref29","doi-asserted-by":"crossref","first-page":"9","DOI":"10.1016\/j.avsg.2010.04.003","article-title":"Incidence and characteristics of venous thromboembolic disease during pregnancy and the postnatal period: a contemporary series","volume":"25","author":"D J O'Connor","year":"2011","journal-title":"Ann Vasc Surg"},{"issue":"12","key":"ref30","doi-asserted-by":"crossref","first-page":"997","DOI":"10.7326\/0003-4819-129-12-199812150-00002","article-title":"Use of a clinical model for safe management of patients with suspected pulmonary embolism","volume":"129","author":"P S Wells","year":"1998","journal-title":"Ann Intern Med"},{"issue":"19","key":"ref31","doi-asserted-by":"crossref","first-page":"2131","DOI":"10.1001\/archinte.168.19.2131","article-title":"Simplification of the revised Geneva score for assessing clinical probability of pulmonary embolism","volume":"168","author":"F A Klok","year":"2008","journal-title":"Arch Intern Med"},{"issue":"12","key":"ref32","doi-asserted-by":"crossref","first-page":"1461","DOI":"10.3109\/14767058.2011.614652","article-title":"The application of a clinical risk stratification score may reduce unnecessary investigations for pulmonary embolism in pregnancy","volume":"24","author":"C O'Connor","year":"2011","journal-title":"J Matern Fetal Neonatal Med"},{"issue":"12","key":"ref33","doi-asserted-by":"crossref","first-page":"1139","DOI":"10.1056\/NEJMoa1813865","article-title":"Pregnancy-adapted YEARS algorithm for diagnosis of suspected pulmonary embolism","volume":"380","author":"L M van der Pol","year":"2019","journal-title":"N Engl J Med"},{"issue":"01","key":"ref34","first-page":"132","article-title":"Enhanced thrombin generation and fibrinolytic activity in normal pregnancy and the puerperium","volume":"80","author":"K Bremme","year":"1992","journal-title":"Obstet Gynecol"},{"issue":"11","key":"ref35","doi-asserted-by":"crossref","first-page":"611","DOI":"10.1007\/s00277-002-0549-1","article-title":"Tissue plasminogen activator levels change with plasma fibrinogen concentrations during pregnancy","volume":"81","author":"J W Choi","year":"2002","journal-title":"Ann Hematol"},{"issue":"03","key":"ref36","doi-asserted-by":"crossref","first-page":"165","DOI":"10.7326\/0003-4819-147-3-200708070-00005","article-title":"A red blood cell agglutination D-dimer test to exclude deep venous thrombosis in pregnancy","volume":"147","author":"W S Chan","year":"2007","journal-title":"Ann Intern Med"},{"issue":"05","key":"ref37","doi-asserted-by":"crossref","first-page":"1004","DOI":"10.1111\/j.1538-7836.2010.03783.x","article-title":"D-dimer testing in pregnant patients: towards determining the next \u2018level\u2019 in the diagnosis of deep vein thrombosis","volume":"8","author":"W S Chan","year":"2010","journal-title":"J Thromb Haemost"},{"issue":"03","key":"ref38","doi-asserted-by":"crossref","first-page":"395","DOI":"10.1111\/1471-0528.12855","article-title":"Gestation-specific D-dimer reference ranges: a cross-sectional study","volume":"122","author":"N Murphy","year":"2015","journal-title":"BJOG"},{"issue":"08","key":"ref39","doi-asserted-by":"crossref","first-page":"983","DOI":"10.3109\/14767058.2014.940891","article-title":"Establishing reference intervals for D-dimer to trimesters","volume":"28","author":"\u015e Ercan","year":"2015","journal-title":"J Matern Fetal Neonatal Med"},{"issue":"06","key":"ref40","doi-asserted-by":"crossref","first-page":"1326","DOI":"10.1097\/AOG.0b013e3181c2bde8","article-title":"Pregnancy and laboratory studies: a reference table for clinicians","volume":"114","author":"M Abbassi-Ghanavati","year":"2009","journal-title":"Obstet Gynecol"},{"issue":"02","key":"ref41","doi-asserted-by":"crossref","first-page":"e160","DOI":"10.1055\/s-0036-1582136","article-title":"Diagnosing pulmonary embolism in pregnancy: are biomarkers and clinical predictive models useful?","volume":"6","author":"B V Parilla","year":"2016","journal-title":"AJP Rep"},{"issue":"07","key":"ref42","doi-asserted-by":"crossref","first-page":"844","DOI":"10.1177\/1076029616673732","article-title":"Thrombosis prediction based on reference ranges of coagulation-related markers in different stages of pregnancy","volume":"23","author":"A Sekiya","year":"2017","journal-title":"Clin Appl Thromb Hemost"},{"issue":"11","key":"ref43","doi-asserted-by":"crossref","first-page":"766","DOI":"10.7326\/M18-1670","article-title":"Diagnosis of pulmonary embolism during pregnancy: a multicenter prospective management outcome study","volume":"169","author":"M Righini","year":"2018","journal-title":"Ann Intern Med"},{"issue":"03","key":"ref44","doi-asserted-by":"crossref","first-page":"383","DOI":"10.1111\/1471-0528.15286","article-title":"The DiPEP study: an observational study of the diagnostic accuracy of clinical assessment, D-dimer and chest x-ray for suspected pulmonary embolism in pregnancy and postpartum","volume":"126","author":"S Goodacre","year":"2019","journal-title":"BJOG"},{"key":"ref45","doi-asserted-by":"crossref","first-page":"m2177","DOI":"10.1136\/bmj.m2177","article-title":"Pulmonary embolism: update on management and controversies","volume":"370","author":"L Duffett","year":"2020","journal-title":"BMJ"}],"container-title":["American Journal of Perinatology"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/www.thieme-connect.de\/products\/ejournals\/pdf\/10.1055\/a-2112-8049.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,11,5]],"date-time":"2024-11-05T13:54:59Z","timestamp":1730814899000},"score":1,"resource":{"primary":{"URL":"http:\/\/www.thieme-connect.de\/DOI\/DOI?10.1055\/a-2112-8049"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,6,19]]},"references-count":45,"journal-issue":{"issue":"S 01","published-online":{"date-parts":[[2024,5,13]]},"published-print":{"date-parts":[[2024,5]]}},"URL":"https:\/\/doi.org\/10.1055\/a-2112-8049","archive":["Portico","CLOCKSS"],"relation":{},"ISSN":["0735-1631","1098-8785"],"issn-type":[{"value":"0735-1631","type":"print"},{"value":"1098-8785","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2023,6,19]]},"published":{"date-parts":[[2023,6,19]]}}}