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Not everyone suspected to have PE should have a V/Q scan or CTPA. The attending clinicians will decide if this is the appropriate course of action. There are a lot more mundane conditions which could mimic this serious condition, including such things as muscle or ligament sprain, pressure pain from the fetal limbs in late pregnancy (under the ribs) and some self-limiting viral respiratory infections.

MRI is also increasingly used as a diagnostic tool for suspected PE.

X-ray use during pregnancy

A chest X-ray involves radiation. So does a V/Q scan and CTPA. However, precautions are taken to shield the womb and its contents. Moreover, the amount of radiation involved is considered safe. A V/Q scan involves a dose of radiation that is one-tenth of the maximum dose considered safe in pregnancy. A chest X-ray involves an even lower dose.

Treatment for pulmonary embolism in Pregnancy

The mainstay of treatment for PE in pregnancy is the anticoagulant heparin. In pulmonary embolism, this may be given in the form of continuous infusion at a much higher dose than that used in uncomplicated deep vein thrombosis. Special tests will be carried out regularly to ensure that the right effective dose is being given. This may continue for a few days before switching to heparin/LMWH injections. Treatment will continue for the remainder of the pregnancy and for at least six weeks after delivery but this could be longer, even several months. Assessment of risk is made to determine this.

PE treatment success

In the majority of cases, the treatment described above is successful. In some very serious cases, this may be insufficient and very specialized surgical intervention may be necessary as a life-saving measure. This is rare.

Safety of heparin in pregnancy

Heparin does not cross the placenta and therefore, as far as the baby is concerned, it is perfectly safe. Regular tests will be carried out to ensure that an optimal dose is being given to the mother.

Too much heparin can cause bleeding tendencies and, if tests show evidence of this, the dose will be adjusted downwards.

Another problem associated with prolonged heparin use has been the risk of osteoporosis. In rare instances, this has been known to lead to bone fractures.

However, the benefits of treatment far outweigh the potential risk.

Low-molecular weight heparins (LMWH) and risk of osteoporosis

LMWH are also a risk factor for osteoporosis but to a much lower degree. There is a number of LMWH preparations. Common brands include Fragmin® (Dalteparin), Clexane® (Enoxaparin) and Innohep® (Tinzaparin).

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