title: Diagnosis of pregnancy-associated venous thromboembolism - position paper of the Working Group in Women's Health of the Society of Thrombosis and Haemostasis (GTH).
abstract: Pregnancy and the postpartum period are associated with an increased risk of venous thromboembolism (VTE). Over the past decade, new diagnostic algorithms have been established, combining clinical probability, laboratory testing and imaging studies for the diagnosis of deep vein thrombosis (DVT) and pulmonary embolism (PE) in the non-pregnant population. However, there is no such generally accepted algorithm for the diagnosis of pregnancy-associated VTE. Studies establishing clinical prediction rules have excluded pregnant women, and prediction scores currently in use have not been prospectively validated in pregnancy or during the postpartum period. D-dimers physiologically increase throughout pregnancy and peak at delivery, so a negative D-dimer test result, based on the reference values of non-pregnant subjects, becomes unlikely in the second and third trimesters. Imaging studies therefore play a major role in confirming suspected DVT or PE in pregnant women. Major concerns have been raised against radiologic imaging because of foetal radiation exposure, and doubts about the diagnostic value of ultrasound techniques in attempting to exclude isolated iliac vein thrombosis grow stronger as pregnancy progresses. As members of the Working Group in Women's Health of the Society of Thrombosis and Haemostasis (GTH), we summarise evidence from the available literature and aim to establish a more uniform strategy for diagnosing pregnancy-associated VTE.
authors.affiliation: 1 Medical Practice of Angiology and Haemostaseology, Praxis am Grüneburgweg, Frankfurt/Main, Germany.
authors.forename: Birgit
authors.initials: B
authors.lastname: Linnemann
authors.affiliation: 2 Klinikum Darmstadt, Klinik für Gefäßmedizin - Angiologie, Darmstadt, Germany.|9 Centrum für Thrombose und Hämostase (CTH), Johannes-Gutenberg-Universität, Mainz, Germany.
authors.forename: Rupert
authors.initials: R
authors.lastname: Bauersachs
authors.affiliation: 3 Gerinnungszentrum Rhein Ruhr, Duisburg, Germany.
authors.forename: Hannelore
authors.initials: H
authors.lastname: Rott
authors.affiliation: 3 Gerinnungszentrum Rhein Ruhr, Duisburg, Germany.
authors.forename: Susan
authors.initials: S
authors.lastname: Halimeh
authors.affiliation: 4 Centrum für Blutgerinnungsstörungen und Transfusionsmedizin, Düsseldorf, Germany.
authors.forename: Rainer
authors.initials: R
authors.lastname: Zotz
authors.affiliation: 5 Blutgerinnung Ulm, Germany.
authors.forename: Andrea
authors.initials: A
authors.lastname: Gerhardt
authors.affiliation: 6 Nuramed, Gemeinschaftspraxis für Radiologie und Nuklearmedizin, Köln, Germany.
authors.forename: Barbara
authors.initials: B
authors.lastname: Boddenberg-Pätzold
authors.affiliation: 7 Gynäkologische Endokrinologie und Fertilitätsstörungen, Ruprecht-Karls-Universität Heidelberg.
authors.forename: Bettina
authors.initials: B
authors.lastname: Toth
authors.affiliation: 8 Zentrum für Blutgerinnungsstörungen, MVZ Labor Dr. Reising-Ackermann und Kollegen, Leipzig, Germany.
authors.forename: Ute
authors.initials: U
authors.lastname: Scholz
mesh_terms: D015415:Biomarkers / Q000097:blood; D032921:Consensus; D003952:Diagnostic Imaging / Q000009:adverse effects / Q000379:methods / Q000592:standards*; D005260:Female; D005338:Fibrin Fibrinogen Degradation Products / Q000032:analysis*; D006801:Humans; D011237:Predictive Value of Tests; D011247:Pregnancy; D011249:Pregnancy Complications, Cardiovascular / Q000097:blood / Q000175:diagnosis* / Q000209:etiology; D011655:Pulmonary Embolism / Q000097:blood / Q000175:diagnosis* / Q000209:etiology; D015203:Reproducibility of Results; D012307:Risk Factors; D054556:Venous Thromboembolism / Q000097:blood / Q000175:diagnosis* / Q000209:etiology; D020246:Venous Thrombosis / Q000097:blood / Q000175:diagnosis* / Q000209:etiology
chemical_list: D015415:Biomarkers; D005338:Fibrin Fibrinogen Degradation Products; C036309:fibrin fragment D
keywords: Venous thromboembolism; computed tomography; diagnosis; lung scintigraphy; pregnancy; ultrasonography