MBBS;MS. FICOG. MICOG.
Founder Principal & Controller,
Jhalawar Medical College and Hospital Jhalawar.
Ex Principal and Controller,
Mahatma Gandhi Medical College & hosptal ;
It is not an uncommon cause of MMR—
responsible for 10%MMR.
Occurs as 1:7000 pregnancy.
Incidence are equal in ANC and purperium ,
but MMR is more in delivered women.
70% 0f women developing PE have pre
50% of DVT cases may develop silent PE due
to dislodgement of small / tiny thrombus.
Massive embolism i.e. obstruction of >50%
of pulmonary arterial circulation is likely to
be associated with right side heart failure.
Massive embolism leads to haemodynamic
instability. Increased pulmonary vascular
resistance and hypertension,which develops
when 60-70 % pulmonary vascular tree is
occluded by embolus . Right ventricular
Not to forget PE may be silent
Ventilation perfusion scintigraphy (lung scan )
X ray chest PA & lateral view.
Diagnostic tests for Coagulation and fibrinolysis.
PO2 studies in pulmonary and aortic circulation .
Clinical examination alone is able to confirm only
20-30% of cases of DVT
International Normalised Ratio (INR).
Current D-dimer assays have predictive value for
DVT, and PE
INR is useful for guiding the management of
patients with known DVT who are on warfarin
Xray Chest--Loss of vascular markings in the lung field
where blood circulation is blocked by embolus.
Atelectasis, hemidiaphragm elevation , pleural effusion.
Echocardiography ---- dilatation of right ventricle.,
increased pulmonary vascular resistance and pulmonary
ECG---Right axis deviationT wave inversion in anterior
chest leads. Sinus tachycardia,S1 Q3T 3 pattern.
D-dimmer is a specific degradation product of
cross-linked fibrin. Because concurrent
production and breakdown of clot
characterize thrombosis, patients with
thromboembolic disease have elevated levels
three major approaches for measuring D-
blood agglutination test
recent (within 10 days) surgery or trauma,
recent myocardial infarction or stroke,
disseminated intravascular coagulation,
pregnancy or recent delivery,
active collagen vascular disease, or metastatic
cancer False-positive D-dimers
occur in patients with PE
D – Dimer tests to be done ---