This document discusses pulmonary embolism (PE). PE occurs in about 10% of maternal mortality cases and has an incidence of 1 in 7,000 pregnancies. 70% of women who develop PE have a pre-existing deep vein thrombosis (DVT). Massive PE leads to right heart failure and hemodynamic instability when over 50% of the pulmonary arteries are blocked. Investigations to diagnose PE include lung scans, MRI, pulmonary angiography and echocardiography. D-dimer and coagulation tests can also help in diagnosis, while chest X-rays and ECG may show signs of PE. PE treatment focuses on anticoagulation to prevent further clots.

1. Pulmonary Embolism
 Prof. M.C.Bansal
 MBBS;MS. FICOG. MICOG.
 Founder Principal & Controller,
Jhalawar Medical College and Hospital Jhalawar.
 Ex Principal and Controller,
 Mahatma Gandhi Medical College & hosptal ;
Sitapura Jaipur.

2. Introduction
 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
existing DVT.
 50% of DVT cases may develop silent PE due
to dislodgement of small / tiny thrombus.

4. PE Clinical
Presentation
 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
dilatation develops.
 Not to forget PE may be silent

11. Investigations
 Ventilation perfusion scintigraphy (lung scan )
 MRI
 Pulmonary angiography.
 Echo cardiography.
 X ray chest PA & lateral view.
 ECG .
 Diagnostic tests for Coagulation and fibrinolysis.
 PO2 studies in pulmonary and aortic circulation .

12. Diagnostic Tests--
 Clinical examination alone is able to confirm only
20-30% of cases of DVT
 BloodTests
 the D-dimer
 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
(Coumadin)

14.  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
hypertension.
 ECG---Right axis deviationT wave inversion in anterior
chest leads. Sinus tachycardia,S1 Q3T 3 pattern.

15. D-dimmer
 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
of D-dimer
 three major approaches for measuring D-
dimer
 ELISA
 latex agglutination
 blood agglutination test

16.  recent (within 10 days) surgery or trauma,
 recent myocardial infarction or stroke,
 acute infection,
 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 ---

18. Embolus in Pulmonary Trunk

19. Pulmonary Embolism

20. Pulmonary Embolism