Congress:
EuroSafe Imaging 2021
Keywords:
Obstetrics (Pregnancy / birth / postnatal period), Pulmonary vessels, Radioprotection / Radiation dose, CT, Plain radiographic studies, Ultrasound, Audit and standards, Education, Radiation safety, Education and training, Embolism / Thrombosis, Obstetrics
Authors:
K. V. Harries, H. T. V. Sivashankar, S. Syed, I. Syed, N. Balaji
DOI:
10.26044/esi2021/ESI-12385
Methods or background
Venous thromboembolism (VTE) is one of the UK’s leading cause of maternal mortality.
According to the most recent MBRRACE report, VTE is the third leading causing of maternal death during pregnancy and perinatal period (1). The absolute risk is around 1 in 1000 pregnancies, and the threat increases by 20-fold in the first 6 weeks following birth (2).
In addition to the physiological changes that occur during pregnancy which increases the risk of VTE considerably(3), other risk factors include; hyperemesis gravidarium, ovarian hyperstimulation, IVF and Caesarean section (2).
Therefore, accurate diagnosis and utilisation of imaging protocols is paramount. However, understanding and knowledge of this diagnostic pathway was seemingly poor. We aimed to investigate and inform doctors on the guidance.
RCOG guidelines on Investigations for suspected VTE
The RCOG released revised guidelines in 2015, detailing the ideal utilisation of diagnostic imaging for VTE in pregnancy. When a women presents with clinically suspected VTE, following the first stage of assessment and blood tests, Low-molecular-weight-heparin should be started without delay (2). D-dimer should not be performed in investigation of VTE in pregnancy, as there is a usually a natural rise throughout gestation.
The primary diagnostic test for an acute DVT is compression duplex ultrasound. For an acute PE, an ECG and Chest radiograph is the first investigation before a further imaging. If the Chest radiograph is normal, a V/Q scan should be undertaken and if abnormal, a CTPA with adequate shielding for the foetus, is recommended. The rationale for this is to minimise unnecessary radiation to the foetus and the maternal breast tissue (2).