title: An official American Thoracic Society/Society of Thoracic Radiology clinical practice guideline: evaluation of suspected pulmonary embolism in pregnancy.
abstract: BACKGROUND
  Pulmonary embolism (PE) is a leading cause of maternal mortality in the developed world. Along with appropriate prophylaxis and therapy, prevention of death from PE in pregnancy requires a high index of clinical suspicion followed by a timely and accurate diagnostic approach.
  
  
  METHODS
  To provide guidance on this important health issue, a multidisciplinary panel of major medical stakeholders was convened to develop evidence-based guidelines for evaluation of suspected pulmonary embolism in pregnancy using the Grades of Recommendation, Assessment, Development, and Evaluation (GRADE) system. In formulation of the recommended diagnostic algorithm, the important outcomes were defined to be diagnostic accuracy and diagnostic yield; the panel placed a high value on minimizing cumulative radiation dose when determining the recommended sequence of tests.
  
  
  RESULTS
  Overall, the quality of the underlying evidence for all recommendations was rated as very low or low, with some of the evidence considered for recommendations extrapolated from studies of the general population. Despite the low-quality evidence, strong recommendations were made for three specific scenarios: performance of chest radiography (CXR) as the first radiation-associated procedure; use of lung scintigraphy as the preferred test in the setting of a normal CXR; and performance of computed-tomographic pulmonary angiography (CTPA) rather than digital subtraction angiography (DSA) in a pregnant woman with a nondiagnostic ventilation-perfusion (V/Q) result.
  
  
  CONCLUSIONS
  The recommendations presented in this guideline are based upon the currently available evidence; availability of new clinical research data and development and dissemination of new technologies will necessitate a revision and update.
authors.forename: Ann N
authors.initials: AN
authors.lastname: Leung
authors.forename: Todd M
authors.initials: TM
authors.lastname: Bull
authors.forename: Roman
authors.initials: R
authors.lastname: Jaeschke
authors.forename: Charles J
authors.initials: CJ
authors.lastname: Lockwood
authors.forename: Phillip M
authors.initials: PM
authors.lastname: Boiselle
authors.forename: Lynne M
authors.initials: LM
authors.lastname: Hurwitz
authors.forename: Andra H
authors.initials: AH
authors.lastname: James
authors.forename: Laurence B
authors.initials: LB
authors.lastname: McCullough
authors.forename: Yusuf
authors.initials: Y
authors.lastname: Menda
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Paidas
authors.forename: Henry D
authors.initials: HD
authors.lastname: Royal
authors.forename: Victor F
authors.initials: VF
authors.lastname: Tapson
authors.forename: Helen T
authors.initials: HT
authors.lastname: Winer-Muram
authors.forename: Frank A
authors.initials: FA
authors.lastname: Chervenak
authors.forename: Dianna D
authors.initials: DD
authors.lastname: Cody
authors.forename: Michael F
authors.initials: MF
authors.lastname: McNitt-Gray
authors.forename: Christopher D
authors.initials: CD
authors.lastname: Stave
authors.forename: Brandi D
authors.initials: BD
authors.lastname: Tuttle
mesh_terms: D003287:Contrast Media / Q000009:adverse effects; D005260:Female; D005338:Fibrin Fibrinogen Degradation Products / Q000032:analysis; D006801:Humans; D007866:Leg / Q000098:blood supply / Q000000981:diagnostic imaging; D008168:Lung / Q000000981:diagnostic imaging; D008279:Magnetic Resonance Imaging; D011247:Pregnancy; D011249:Pregnancy Complications, Cardiovascular / Q000175:diagnosis* / Q000000981:diagnostic imaging; D011655:Pulmonary Embolism / Q000150:complications / Q000175:diagnosis* / Q000000981:diagnostic imaging; D011829:Radiation Dosage; D013902:Radiography, Thoracic / Q000009:adverse effects; D011877:Radionuclide Imaging; D014463:Ultrasonography
chemical_list: D003287:Contrast Media; D005338:Fibrin Fibrinogen Degradation Products; C036309:fibrin fragment D