Pulmonary embolism during pregnancy: a 17-year single-center retrospective MDCT pulmonary angiography study

Abstract Objectives To determine the prevalence of pulmonary embolism (PE) and alternative diagnoses detected by computed tomography pulmonary angiography (CTPA) in pregnant women; and to assess changes over time regarding radiation dose, technical quality, and examination frequency. Materials and methods This retrospective study included all pregnant women referred for CTPA due to clinically suspected PE over 17 years. Two blinded radiologists reviewed the CTPAs in consensus with regard to PE, alternative diagnoses, and technical quality. We retrieved patient data regarding radiation dose metrics and associated clinical and laboratory parameters. Subgroup comparisons were performed (Wilcoxon and Kruskal-Wallis tests). Results Of the 237 identified patients, 8 (3.3%) were excluded due to inadequate technical CTPA quality, and 229 patients were analyzed (mean age, 31.7 years; mean gestational age, 28 ± 7 weeks). The four different CT systems used over the study period had similar technical quality (p = 0.28). Of 229 patients 16 (7%) patients had PE, 144 (62.9%) had no abnormal findings, and 69 (30.1%) had an alternative diagnosis (consolidation, other pulmonary opacities, pleural effusion, and basal atelectasis). Gestational age, symptoms, and D-dimer levels were not significantly different between patients with or without PE (p > 0.05). Over time, radiation dose exposure decreased by 30% (p < 0.001), while the number of annual examinations increased by > 4-folds. Conclusions In pregnant women, CTPA rarely indicates PE and more often shows alternative diagnoses. Over 17 years, the use of CTPA in pregnancy has notably increased, while the radiation dose exposure has decreased by one third. Key Points • The use of CTPA in pregnancy has steadily risen over the last 17 years • In pregnant women, CTPA rarely reveals PE and more often shows alternative diagnoses • Recent technical improvements have substantially decreased the radiation dose exposure inherent in CTPA without reducing diagnostic image quality

Download Full-text

A Systematic Review of Double Low-dose CT Pulmonary Angiography in Pulmonary Embolism

Current Medical Imaging Formerly Current Medical Imaging Reviews ◽

10.2174/1573405614666180813120619 ◽

2019 ◽

Vol 15 (5) ◽

pp. 453-460 ◽

Cited By ~ 1

Author(s):

Sultan Aldosari ◽

Zhonghua Sun

Keyword(s):

Systematic Review ◽

Pulmonary Embolism ◽

Image Quality ◽

Radiation Dose ◽

Contrast Medium ◽

Low Dose ◽

Pulmonary Angiography ◽

Ct Pulmonary Angiography ◽

Low Contrast ◽

Low Contrast Medium

Background: The aim of this study is to perform a systematic review of the feasibility and clinical application of double low-dose CT pulmonary angiography (CTPA) in the diagnosis of patients with suspected pulmonary embolism. Discussion: A total of 13 studies were found to meet selection criteria reporting both low radiation dose (70 or 80 kVp versus 100 or 120 kVp) and low contrast medium dose CTPA protocols. Lowdose CTPA resulted in radiation dose reduction from 29.6% to 87.5% in 12 studies (range: 0.4 to 23.5 mSv), while in one study, radiation dose was increased in the dual-energy CT group when compared to the standard 120 kVp group. CTPA with use of low contrast medium volume (range: 20 to 75 ml) was compared to standard CTPA (range: 50 to 101 ml) in 12 studies with reduction between 25 and 67%, while in the remaining study, low iodine concentration was used with 23% dose reduction achieved. Quantitative assessment of image quality (in terms of signal-to-noise ratio and contrast-to-noise ratio) showed that low-dose CTPA was associated with higher, lower and no change in image quality in 3, 3 and 6 studies, respectively when compared to the standard CTPA protocol. The subjective assessment indicated similar image quality in 11 studies between low-dose and standard CTPA groups, and improved image quality in 1 study with low-dose CTPA. Conclusion: This review shows that double low-dose CTPA is feasible in the diagnosis of pulmonary embolism with significant reductions in both radiation and contrast medium doses, without compromising diagnostic image quality.

Download Full-text

Fish Oil Supplementation in Pregnancy Increases Gestational Age, Size for Gestational Age, and Birth Weight in Infants: A Randomized Controlled Trial

Journal of Nutrition ◽

10.1093/jn/nxy204 ◽

2018 ◽

Vol 149 (4) ◽

pp. 628-634 ◽

Cited By ~ 8

Author(s):

Rebecca Kofod Vinding ◽

Jakob Stokholm ◽

Astrid Sevelsted ◽

Bo L Chawes ◽

Klaus Bønnelykke ◽

...

Keyword(s):

Randomized Controlled Trial ◽

Birth Weight ◽

Pregnant Women ◽

Gestational Age ◽

Controlled Trial ◽

Growth Curves ◽

Vitamin D Supplementation ◽

Double Blind ◽

Randomized Controlled ◽

In Pregnancy

ABSTRACT Background Randomized trials have reported that supplementation with n–3 long-chain polyunsaturated fatty acids (LCPUFAs) in pregnancy can prolong pregnancy and thereby increase birth weight. Objective We aimed to examine the relations of n–3 LCPUFA supplementation in pregnancy with duration of pregnancy, birth weight, and size for gestational age (GA). Methods This was a double-blind randomized controlled trial conducted in 736 pregnant women and their offspring, from the Copenhagen Prospective Studies on Asthma in Childhood2010cohort. They were recruited between weeks 22 and 26 in pregnancy and randomly assigned to either of 2.4 g n–3 LCPUFA or control (olive oil) daily until 1 wk after birth. Exclusion criteria were endocrine, cardiovascular, or nephrologic disorders and vitamin D supplementation intake >600 IU/d. In this study we analyzed secondary outcomes, and further excluded twin pregnancies and extrauterine death. The primary outcome for the trial was persistent wheeze or asthma. Results The random assignment ran between 2008 and 2010. Six hundred and ninety-nine mother-infant pairs were included in the analysis. n–3 LCPUFA compared with control was associated with a 2-d prolongation of pregnancy [median (IQR): 282 (275–288) d compared with 280 (273–286) d, P = 0.02], a 97-g higher birth weight (mean ± SD: 3601 ± 534 g compared with 3504 ± 528 g, P = 0.02), and an increased size for GA according to the Norwegian population-based growth curves-Skjærven (mean ± SD: 49.9 ± 28.3 percentiles compared with 44.5 ± 27.6 percentiles, P = 0.01). Conclusion Supplementing pregnant women with n–3 LCPUFAs during the third trimester is associated with prolonged gestation and increased size for GA, leading to a higher birth weight in this randomized controlled trial. This trial was registered at clinicaltrials.gov as NCT00798226.

Download Full-text

Diagnostic imaging to investigate pulmonary embolism in pregnancy using CT-Pulmonary angiography versus perfusion scan

Journal of Research in Medical Sciences ◽

10.4103/jrms.jrms_113_20 ◽

2021 ◽

Vol 26 (1) ◽

pp. 37

Author(s):

Zahra Arabi ◽

Somayeh Sadeghi ◽

Maryam Moradi ◽

Elham Raofi

Keyword(s):

Pulmonary Embolism ◽

Diagnostic Imaging ◽

Pulmonary Angiography ◽

Ct Pulmonary Angiography ◽

Perfusion Scan ◽

In Pregnancy

Download Full-text

Outcomes of Negative Multidetector Computed Tomography with Pulmonary Angiography in Pregnant Women Suspected of Pulmonary Embolism

Lung ◽

10.1007/s00408-011-9329-9 ◽

2011 ◽

Vol 190 (1) ◽

pp. 105-111 ◽

Cited By ~ 16

Author(s):

Ghada Bourjeily ◽

Hanan Khalil ◽

Christina Raker ◽

Susan Martin ◽

Pauline Auger ◽

...

Keyword(s):

Computed Tomography ◽

Pulmonary Embolism ◽

Pregnant Women ◽

Multidetector Computed Tomography ◽

Pulmonary Angiography

Download Full-text

Pengaruh Teknik Akupressure Terhadap Nyeri Punggung Pada Ibu Hamil Di Wilayah Puskesmas Jogonalan I Klaten

Jurnal Kebidanan dan Kesehatan Tradisional ◽

10.37341/jkkt.v3i1.61 ◽

2018 ◽

Vol 3 (1) ◽

Author(s):

Niken Tri Sukeksi ◽

Gita Kostania ◽

Emy Suryani

Keyword(s):

Back Pain ◽

Data Analysis ◽

Experimental Design ◽

Pregnant Women ◽

Test Data ◽

Gestational Age ◽

Severe Pain ◽

Third Trimester ◽

Labour Process ◽

In Pregnancy

Abstract: Acupressure, Back Pain, Pregnancy. Acupressure is effective to relieve back pain in Meridian point. Acupressure technique is done to help pregnant women in relieving complaints in pregnancy such as nausea and vomiting. In labour process, this technique can be an induction of labor, and can reduce anxiety. The purpose is to know the influence of acupressure technique to relieve back pain for pregnant women in Puskesmas Jogonalan I area of Klaten. Research is pre experimental design with one group pretest posttest approach. The population is all pregnant women in Puskesmas Jogonalan I area of Klaten. The population target is all third trimester of pregnant women in Puskesmas Jogonalan I area of Klaten. Technique sampling is purposive sampling with 30 peopole, ang using t-test data analysis. The characteristics of respondents showed that most of them are 20-35 years old, their gestational age are 3137 weeks, their occupation are housewives, and most of them have 2-3 children. Degree of back pain in pregnant women before acupressure as many as 21 people (70%) are in severe pain. Degree of back pain in pregnant women after given acupressure as many as 24 people (80%) are in mild pain. There is influence of acupressure technique to relieve back pain for pregnant women in Puskesmas Jogonalan I area of Klaten (t =9,893; p=0,001<0,05).

Download Full-text

Application of physiologically based pharmacokinetic modeling for sertraline dosing recommendations in pregnancy

npj Systems Biology and Applications ◽

10.1038/s41540-020-00157-3 ◽

2020 ◽

Vol 6 (1) ◽

Author(s):

Blessy George ◽

Annie Lumen ◽

Christine Nguyen ◽

Barbara Wesley ◽

Jian Wang ◽

...

Keyword(s):

Pregnant Women ◽

Gestational Age ◽

Drug Exposure ◽

Pbpk Model ◽

Pbpk Modeling ◽

Quantitative Prediction ◽

Pharmacokinetic Parameters ◽

Physiologically Based Pharmacokinetic ◽

Physiologically Based ◽

In Pregnancy

Abstract Pregnancy is a period of significant change that impacts physiological and metabolic status leading to alterations in the disposition of drugs. Uncertainty in drug dosing in pregnancy can lead to suboptimal therapy, which can contribute to disease exacerbation. A few studies show there are increased dosing requirements for antidepressants in late pregnancy; however, the quantitative data to guide dose adjustments are sparse. We aimed to develop a physiologically based pharmacokinetic (PBPK) model that allows gestational-age dependent prediction of sertraline dosing in pregnancy. A minimal physiological model with defined gut, liver, plasma, and lumped placental-fetal compartments was constructed using the ordinary differential equation solver package, ‘mrgsolve’, in R. We extracted data from the literature to parameterize the model, including sertraline physicochemical properties, in vitro metabolism studies, disposition in nonpregnant women, and physiological changes during pregnancy. The model predicted the pharmacokinetic parameters from a clinical study with eight subjects for the second trimester and six subjects for the third trimester. Based on the model, gestational-dependent changes in physiology and metabolism account for increased clearance of sertraline (up to 143% at 40 weeks gestational age), potentially leading to under-dosing of pregnant women when nonpregnancy doses are used. The PBPK model was converted to a prototype web-based interactive dosing tool to demonstrate how the output of a PBPK model may translate into optimal sertraline dosing in pregnancy. Quantitative prediction of drug exposure using PBPK modeling in pregnancy will support clinically appropriate dosing and increase the therapeutic benefit for pregnant women.

Download Full-text

Performance of Low-Dose Perfusion Scintigraphy and CT Pulmonary Angiography for Pulmonary Embolism in Pregnancy

CHEST Journal ◽

10.1016/j.chest.2017.08.005 ◽

2018 ◽

Vol 153 (1) ◽

pp. 152-160 ◽

Cited By ~ 10

Author(s):

Jean-Ju Sheen ◽

Linda B. Haramati ◽

Anna Natenzon ◽

Hong Ma ◽

Pamela Tropper ◽

...

Keyword(s):

Pulmonary Embolism ◽

Low Dose ◽

Pulmonary Angiography ◽

Ct Pulmonary Angiography ◽

Perfusion Scintigraphy ◽

In Pregnancy

Download Full-text

Clinical Outcomes of Submicroscopic Infections and Correlates of Protection of VAR2CSA Antibodies in a Longitudinal Study of Pregnant Women in Colombia

Infection and Immunity ◽

10.1128/iai.00797-17 ◽

2018 ◽

Vol 86 (4) ◽

Cited By ~ 5

Author(s):

Kenneth Gavina ◽

Sedami Gnidehou ◽

Eliana Arango ◽

Chloe Hamel-Martineau ◽

Catherine Mitran ◽

...

Keyword(s):

Birth Weight ◽

Pregnant Women ◽

Gestational Age ◽

Significant Risk ◽

Adverse Outcomes ◽

Mixed Infections ◽

Content Type ◽

Delivery Outcomes ◽

The Impact ◽

In Pregnancy

ABSTRACTMalaria in pregnancy can cause serious adverse outcomes for the mother and the fetus. However, little is known about the effects of submicroscopic infections (SMIs) in pregnancy, particularly in areas wherePlasmodium falciparumandPlasmodium vivaxcocirculate. A cohort of 187 pregnant women living in Puerto Libertador in northwest Colombia was followed longitudinally from recruitment to delivery. Malaria was diagnosed by microscopy, reverse transcription-quantitative PCR (RT-qPCR), and placental histopathology. Gestational age, hemoglobin concentration, VAR2CSA-specific IgG levels, and adhesion-blocking antibodies were measured during pregnancy. Statistical analyses were performed to evaluate the impact of SMIs on birth weight and other delivery outcomes. Twenty-five percent of women (45/180) were positive for SMIs during pregnancy. Forty-seven percent of infections (21/45) were caused byP. falciparum, 33% were caused byP. vivax, and 20% were caused by mixedPlasmodiumspp. Mixed infections ofP. falciparumandP. vivaxwere associated with lower gestational age at delivery (P= 0.0033), while other outcomes were normal. Over 60% of women had antibodies to VAR2CSA, and there was no difference in antibody levels between those with and without SMIs. The anti-adhesion function of these antibodies was associated with protection from SMI-related anemia at delivery (P= 0.0086). SMIs occur frequently during pregnancy, and while mixed infections of bothP. falciparumandP. vivaxwere not associated with a decrease in birth weight, they were associated with significant risk of preterm birth. We propose that the lack of adverse delivery outcomes is due to functional VAR2CSA antibodies that can protect pregnant women from SMI-related anemia.

Download Full-text