Pulmonary Embolism in Pregnancy and the Postpartum Period

Pulmonary Embolism (PE) is one of the most common medical complications in pregnancy and is a leading cause of maternal mortality. All women should undergo risk stratification for venous thromboembolism (VTE) during pre-conception or early pregnancy evaluation, if adverse events occur during pregnancy, and pre-delivery or immediately post-partum. Due to a frequently nonspecific presentation, a high index of suspicion is necessary to make timely diagnosis. Chest imaging, either CTA or V/Q scanning, is indicated despite theoretical concerns about fetal and maternal radiation exposure. Treatment consists of prompt initiation of anticoagulation which is continued for at least 6 weeks postpartum and three months total from the PE diagnosis. The chapter presents a novel algorithmic approach to the diagnosis and management of the stable and unstable pregnant patient with suspected PE.