Diagnosing and treating pulmonary embolism during pregnancy
Deep vein thrombosis is the most common cause of pulmonary embolism
As a father of four children, I know that any time an expecting mother gets sick, there is cause for concern. Today, I read an interesting case review in the Annals of Internal Medicine about how to treat a pregnant mom with symptoms of pulmonary embolism.
A pulmonary embolism is a serious medical condition where an artery to the lung gets blocked by a blood clot. These clots typically form in the deep veins of the legs, in a process called deep vein thrombosis.
The patient at issue was a 35-year-old female who is 26 weeks pregnant. She went to an emergency room with complaints of having a two-day history of increasing shortness of breath, pleuritic chest pain (in intense pain when breathing in or out), and chest heaviness. The patient said it felt like someone was sitting on her chest.
One of the standard tests used by emergency physicians, pulmonologists, and critical care doctors to verify or rule out suspected pulmonary embolism is a chest CT angiogram (CTA).
Some patients and healthcare providers may be concerned about the potential radiation risk of such a test being done on a pregnant mother. Of course, the risk of radiation exposure depends on the acute radiation dosage. In addition, experts believe that radiation risk is higher early in pregnancy, particularly in the organogenesis (weeks 2-7 of pregnancy) and weeks 8-15 of the fetogenesis stage.
The physicians reviewing this case for the Annals of Internal Medicine felt that the risk of radiation damage to the fetus was very low for a CT angiogram done on a mother 26 weeks gestation.
Treating a pulmonary embolism
The Royal College of Obstetricians & Gynecologists recommends that women presenting with symptoms of an acute pulmonary embolism have an electrocardiogram and a chest x-ray. If the patient does not have signs of a deep vein thrombosis (DVT), they recommend either a ventilation/perfusion lung scan or a CT pulmonary angiogram.
Interestingly, one of the common tests that is ordered in a pulmonary malaise and workup, D-dimer testing, is not recommended by some experts for pregnant patients.
Once the pulmonary embolism diagnosis is confirmed, the appropriate treatment is to start the patient on an anticoagulation medication, like heparin or low molecular weight heparin (enoxaparin and dalteparin). Obstetricians and maternal-fetal medicine specialists like the selections because they do not cross the placental barrier, meaning that they should pose little to no risk to the baby.
The standard of care requires a 12-week course of anticoagulation medication. The drug should be discontinued 24 hours before delivery of the baby and resumed the day after the baby is born, for the duration of the 12 weeks.
As a Houston, Texas medical malpractice attorney, I have handled many cases involving the diagnosis, mismanagement, and improper treatment of pulmonary embolism in a variety of patients.
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Robert Painter is a medical malpractice attorney at Painter Law Firm PLLC, in Houston, Texas. He is a former hospital administrator who represents patients and family members in medical negligence and wrongful death lawsuits against hospitals, physicians, surgeons, anesthesiologists, and other healthcare providers. A member of the board of directors of the Houston Bar Association, he was honored, in 2017, by H Texas as one of Houston’s top lawyers. In May 2018, the Better Business Bureau recognized Painter Law Firm PLLC with its Award of Distinction.
Robert Painter is a medical malpractice lawyer at Painter Law Firm PLLC.
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