Pulmonary Embolism

Thromboembolic disease is increased in pregnancy. Anticoagulation with heparin is currently the treatment of choice for a pulmonary embolism, along with ensuring adequate oxygenation and treating hypotension. Both unfractionated and low-molecular-weight heparin are acceptable treatment regimens. When a pulmonary embolism is suspected, empiric treatment with heparin should be started immediately, especially if the patient is hypoxic or hemodynamically unstable. Once treatment has begun, a Doppler ultrasound or ventilation-perfusion scan should be obtained to confirm the diagnosis. Traditionally, thrombolytic therapy for pulmonary embolism has been considered relatively contraindicated in pregnant patients. However, pregnant women have been treated successfully with thrombolytics with no untoward complications.17 The use of thrombolytics should be reserved for patients in extremis.

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