HIGH-RISK PULMONARY EMBOLISM IN PREGNANCY: DIAGNOSTIC AND TREATMENT CHALLENGES

Abstract

Aim of the study. To review the pathophysiology, diagnosis, risk stratification, and treatment of high-risk pulmonary embolism in pregnancy. Methods. A literature review was conducted by searching scientific publications in the PubMed database. Articles were selected using keywords and their combinations: pulmonary embolism, pregnancy, risk stratification, diagnosis, and management. Preference was given to systematic reviews and meta-analyses published within the last 10 years, although analytical observational studies and narrative literature reviews were included. Older publications were used for epidemiological data and the review of pathophysiology. Results. High-risk pulmonary embolism leads to right ventricular dysfunction and obstructive shock. While CT pulmonary angiography is the diagnostic gold standard, echocardiography is a valuable tool for unstable patients. Pregnant women should be assessed for the risk of premature death based on the same criteria as in the general population. Systemic thrombolysis may be used when haemodynamic instability is present but has a high bleeding risk. Conclusions. High-risk PE in pregnancy demands rapid diagnosis and risk assessment. Due to the lack of high-quality prospective studies, management should be made individually.