Clinical predictors of pulmonary embolism in pregnancy and immediate postpartum period: a retrospective, analytical study

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Stellenbosch : Stellenbosch University, 2022
ENGLISH ABSTRACT: Background Although pulmonary embolism (PE) is one of the leading causes of death in pregnancy and postpartum, it has low risk of adverse outcome if diagnosed early and treated appropriately. Ventilation-perfusion scanning (VQ scan) or computed tomography pulmonary angiogram (CTPA) are widely used to confirm or diagnose PE, however it carries risks to the mother and the fetus. Up to date, there is no validated clinical predicting tool that can be used in pregnancy and postpartum, thus clinicians face a challenge when suspecting PE in pregnancy and postpartum. Furthermore, the lack of medical resources in low resource environments contributes to the delay of investigations and diagnosis of PE. This study aimed to describe clinical markers for suspicious PE amongst pregnant mothers and immediate postpartum and to design a practical, clinical tool for accurate diagnosis of PE peripartum in our population. Methods The study was performed as a retrospective and analytical study over a period of four months, in the Obstetric Unit at Tygerberg Academic Hospital. The files (total 100) of the patients who were suspected of having PE and underwent imaging (VQ scan or CTPA) were retrospectively evaluated (ECM) to see if there was an association between clinical presentation and PE. All obstetric patients who were imaged for suspected PE, antenatal and immediate postpartum admitted to F2, C2A, OCCU, J2, J4 and J5 were included but not any patients already known with PE or varicose thrombosis. Results There was a statistically significant (P <0.05) association between PE occurrence and ten assessed factors (surgery in <4/52, immobilization >3/7, SOB, hemoptysis, sudden onset of pleuritic chest pain, respiratory alkalosis, sinus tachycardia, deep S1, Q3/T3 and HIV). Conclusion The researcher designed a clinical PE predicting tool that may be used in pregnancy and postpartum.
AFRIKAANSE OPSOMMING: Geen opsomming beskikbaar.
Thesis (PhD) -- Stellenbosch University, 2022.
Pulmonary embolism, Pregnancy -- Complications, Puerperium, Ventilation-perfusion ratio