Clinical Presentation, Management and Outcomes of Pulmonary Embolism in Pregnancy at a Tertiary Academic Hospital in South Africa

Abstract

Pulmonary embolism (PE) is a leading cause of death in pregnant and postpartum women. A record review was performed of women with pregnancy-related PE to evaluate their clinical presentation, management, and outcomes. These women were managed by a multidisciplinary team at the Charlotte Maxeke Johannesburg Academic Hospital, South Africa from 2018-2024. Thirty-three women with antepartum PE and 44 with postpartum PE were identified. The majority were of African ethnicity and had a median age of 29 years old (interquartile range, IQR = 9). Antepartum risk factors were present in 85.0% with antepartum PE, while postpartum risk factors were found in 96% with postpartum PE. At presentation, chest pain, shortness of breath and palpitations were more common in women with antepartum PE compared to postpartum PE (p<0.05). Pre-test probability scores were assessed in a subgroup with d-dimers. Based on the pregnancy-adapted YEARS and Geneva score, imaging would have been required to rule out PE in 87.2% and 73.5% of cases, respectively. Computed tomography pulmonary angiography was the preferred diagnostic modality in 74.0%. Most (97.4%) were treated as inpatients, with 57% requiring initial management in the intensive care unit and/or high care. The median hospital stay was 14 days (IQR = 8). Low-molecular-weight heparin was the most commonly prescribed anticoagulant, with a median treatment duration of 3 months (IQR = 1). The live birth rate was 84.4%. One maternal death occurred; however, this was due to sepsis and unrelated to VTE. The rates of antepartum/secondary postpartum major bleeding and primary postpartum major bleeding were 6.5% and 3.9% respectively. In conclusion, this study provides important insights into the clinical characteristics, multi-disciplinary management, fetal and maternal outcomes of pregnancy-associated PE.