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Int J Emerg Med. 2018 Mar 5;11(1):10. doi: 10.1186/s12245-018-0169-8.

The diagnostic utility of D-dimer and other clinical variables in pregnant and post-partum patients with suspected acute pulmonary embolism.

Author information

1
Emergency Department, University Hospital Lewisham, Lewisham High Street, London, UK. hchoi@doctors.org.uk.
2
St George's School of Medicine, University of London, Cranmer Terrace, London, SW17 0RE, UK.

Abstract

BACKGROUND:

Pulmonary embolism (PE) during pregnancy remains one of the leading causes of maternal morbidity and mortality in the developed world. However, there is a paucity of high-quality evidence resulting in a lack of consensus in managing this group of patients. The aims of the study were to address the diagnostic utility of D-dimer for suspected PE in pregnant and post-partum patients and to identify any clinical presentation variables that are predictors of PE in this group of patients.

METHODS:

A retrospective case note review of 152 pregnant and post-partum patients who underwent diagnostic imaging (ventilation/perfusion (V/Q) or computed tomographic pulmonary angiography (CTPA)) for suspected PE at a tertiary teaching hospital from 2007 to 2011 was conducted. The reference range for D-dimer was less than 0.5 mg/L as being normal. The following variables were also assessed in terms of their predictive capability for PE diagnosis in pregnancy: heart rate (HR), mean arterial pressure (MAP), shock index (SI) and A-a gradient.

RESULTS:

The application of D-dimer testing for suspected PE in this study population had a sensitivity of 100% (95% CI, 73-100%), specificity of 42% (95% CI, 31-53%) and a likelihood negative ratio of 0. None of the clinical variables were significant predictors of PE according to regression analyses.

CONCLUSIONS:

There is supportive evidence that a negative D-dimer result is useful as a means of ruling out PE in pregnant and post-partum patients. However, we need a larger prospective observational study to collaborate the findings.

KEYWORDS:

D-dimer; Post-partum; Pregnancy; Pulmonary embolism

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