What's the optimal diagnostic approach to suspected DVT or PE during pregnancy?

• PE is the leading cause of maternal death in the developed world


• compression ultrasonography does not reliably detect isolated DVTs in the iliac veins, an entity which occurs more commonly during pregnancy


• isolated iliac vein DVTs may be detected w/ magnetic resonance direct thrombus imaging, pulsed doppler or CT


• when considering V/Q versus CTA consider the following: V/Q delivers a higher dose of radiation to the fetus while CTA delivers a higher dose to the mother

Source

Marik, P MD and Plante, L MD. "Venous Thromboembolic Disease and Pregnancy." N Engl J Med 359; 19. 6 Nov 2008.