Diagnosis in women suspected of pulmonary embolism at Chris Hani Baragwanath Academic Hospital – a retrospective review

Abstract

Pulmonary embolism accounts for 3.6% of maternal deaths in South Africa and 9.2% of all pregnancy-related deaths in the United States. This cross-sectional descriptive study sought to identify clinical factors and investigations used in pregnant or postpartum women who presented with suspected pulmonary embolism. Pulmonary embolism (PE) is often one of the conditions that are considered in the differential diagnosis of women attending/admitted at Chris Hani Baragwanath Academic Hospital Obstetric High Care Unit. Women investigated with Computed tomography pulmonary angiogram (CTPA) and/or Ventilation/perfusion (VQ) scans from July 1, 2018, to June 30, 2019, were included. STATA version 14.2 was used for data analysis of the variables. The prevalence of PE was 9.4%. The mean age was 28.2 years (SD+-5.8). Most women, 126 (69.6%), were post-partum and 10 (7.9%) of those diagnosed and treated for PE. There were 81.7% women were delivered by caesarean section and 7.7% of them diagnosed with PE. Hundred (55.2%) women who had a CTPA or VQ scan were symptomatic, and the asymptomatic women had other clinical features suspicious of PE including persistent tachycardia of unknown cause. This was one of the indications for investigation in 159 (87.8%) women. Five (2.8%) women were diagnosed with deep vein thrombosis (DVT) on compressions ultrasound (CUS). Of the 181 scans (CTPA and VQ) done, 12 reports had features suggestive of Pulmonary Embolism. Pulmonary embolism is a rare, but severe condition. It is therefore important to diagnose and treat appropriately.