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Wu Y, Shan D, Chen Q, Hu Y. Could the YEARS algorithm be applied to evaluate suspected pulmonary embolism in hospitalized women after cesarean section? Int J Gynaecol Obstet 2024; 167:374-382. [PMID: 38747718 DOI: 10.1002/ijgo.15573] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2024] [Revised: 04/14/2024] [Accepted: 04/20/2024] [Indexed: 09/25/2024]
Abstract
OBJECTIVE To evaluate the effectiveness of the YEARS algorithm for excluding pulmonary embolism (PE) in hospitalized women after cesarean section. METHODS This retrospective study included postpartum women who gave birth by cesarean section and received computed tomography pulmonary angiography (CTPA) because of suspected PE in the obstetric department between 2015 and 2021. We used the YEARS algorithm in these women retrospectively and assessed its performance to evaluate whether the algorithm could be reliably applied in such cases. RESULTS In all, 225 women were included in the study, of whom 29 (12.9%) women were positive for PE according to the results of CTPA. Upon retrospective application of the YEARS algorithm, 188 (83.6%) women had no YEARS items, while 37 (16.4%) women had YEARS items. Combining the results with D-dimer levels revealed that only 12 (5.3%) women did not need to undergo CTPA, and none showed PE. CONCLUSION The YEARS algorithm could be applied to exclude PE in hospitalized women in the early post-cesarean period. However, the specificity of the YEARS algorithm was very low, and the D-dimer cut-off for ruling out PE in women after early cesarean section should be further studied and optimized.
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Affiliation(s)
- Yuxia Wu
- Department of Ultrasound, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, Ministry of Education, Sichuan University, Chengdu, Sichuan, China
| | - Dan Shan
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, Ministry of Education, Sichuan University, Chengdu, Sichuan, China
- Department of Gynaecology and Obstetrics, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Qian Chen
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, Ministry of Education, Sichuan University, Chengdu, Sichuan, China
- Department of Gynaecology and Obstetrics, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Yayi Hu
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, Ministry of Education, Sichuan University, Chengdu, Sichuan, China
- Department of Gynaecology and Obstetrics, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China
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Zhou W, Qu C, Liu X, Huang J. Diagnostic value of D-dimer to fibrinogen ratio for pulmonary embolism in postpartum women. BMC Pregnancy Childbirth 2024; 24:482. [PMID: 39014319 PMCID: PMC11251229 DOI: 10.1186/s12884-024-06670-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2024] [Accepted: 07/01/2024] [Indexed: 07/18/2024] Open
Abstract
BACKGROUND Pulmonary embolism is a common disease associated with high mortality and morbidity. Diagnosing pulmonary embolism is challenging due to diverse clinical presentations and the lack of specific biomarkers. The study aimed to investigate the diagnostic value on pulmonary embolism for postpartum women by D-dimer to fibrinogen ratio, and it combined with neutrophil-to-lymphocyte ratio or platelet-to-lymphocyte ratio. METHODS A total of 537 women with suspected pulmonary embolism were selected as the research subjects from the Shanghai First Maternity and Infant Hospital between 1 January 2019 and 31 October 2022. The D-dimer to fibrinogen ratio and it combined with neutrophil-to-lymphocyte ratio or platelet-to-lymphocyte ratio were applied to evaluate the clinical probability of pulmonary embolism, and the positive predictive value of both scores were calculated using computed tomography pulmonary arteriography as a gold standard. The diagnostic value of D-dimer to fibrinogen ratio, combined with neutrophil-to-lymphocyte ratio or platelet-to-lymphocyte ratio was evaluated by the area under the curve, sensitivity, specificity, and other indicators in the receiver operator characteristic curve. RESULTS Among the 502 women included for analysis, 194 (38.65%) were definitely diagnosed as pulmonary embolism. The positive predictive values of D-dimer to fibrinogen ratio and it combined with platelet-to-lymphocyte ratio or neutrophil-to-lymphocyte ratio were 70.1%, 50.5%, and 56.5%, respectively in the postpartum women, the area under the curve for the D-dimer to fibrinogen ratio and it combined with platelet-to-lymphocyte ratio or neutrophil-to-lymphocyte ratio were 0.606 (95%CI: 0.562-0.650), 0.624 (95%CI: 0.575-0.673), and 0.639 (95%CI: 0.592-0.686), respectively. The negative predictive values of D-dimer to fibrinogen ratio, it combined with platelet-to-lymphocyte ratio or neutrophil-to-lymphocyte ratio were 50.5%, 70.1%, and 69.8%, respectively. CONCLUSION The diagnostic value of the D-dimer to fibrinogen ratio was higher than the D-dimer for the postpartum women with suspected pulmonary embolism. The combination of either the neutrophil-to-lymphocyte ratio or the platelet-to-lymphocyte ratio with D-dimer to fibrinogen ratio is an appropriate strategy to rule out pulmonary embolism.
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Affiliation(s)
- Wenting Zhou
- Department of Obstetrics and Gynecology, Shanghai Key Laboratory of Maternal Fetal Medicine, Shanghai Institute of Maternal-Fetal Medicine and Gynecologic Oncology, Shanghai First Maternity and Infant Hospital, School of Medicine, Tongji University, No.2699 West Gaoke Road, Pudong New Area, Shanghai, 200092, P.R. China
| | - Cuicui Qu
- Department of Obstetrics and Gynecology, Shanghai Key Laboratory of Maternal Fetal Medicine, Shanghai Institute of Maternal-Fetal Medicine and Gynecologic Oncology, Shanghai First Maternity and Infant Hospital, School of Medicine, Tongji University, No.2699 West Gaoke Road, Pudong New Area, Shanghai, 200092, P.R. China
| | - Xiaohua Liu
- Department of Obstetrics and Gynecology, Shanghai Key Laboratory of Maternal Fetal Medicine, Shanghai Institute of Maternal-Fetal Medicine and Gynecologic Oncology, Shanghai First Maternity and Infant Hospital, School of Medicine, Tongji University, No.2699 West Gaoke Road, Pudong New Area, Shanghai, 200092, P.R. China.
| | - Junfeng Huang
- Department of Intensive Care Medicine, Zhongshan Hospital, Fudan University, 180 Yi Xue Yuan Road, Shanghai, 200032, P.R. China.
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He L, Liu J, Sun R, Qiu L, Tang L, Gao Y. Risk factors related to venous thromboembolism in pregnant women: a meta-analysis. INT ANGIOL 2024; 43:323-330. [PMID: 39041782 DOI: 10.23736/s0392-9590.24.05141-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/24/2024]
Abstract
INTRODUCTION The aim of this paper was to make a preliminary analysis of the risk factors related to venous thromboembolism (VTE) in pregnant women by Meta-analysis. EVIDENCE ACQUISITION Three databases including PubMed, Web of Science, and The National Library of Medicine (NLM) were systematically searched from their establishment to January 1, 2023, and the obtained data were statistically analyzed using RevMan5.3 software. EVIDENCE SYNTHESIS A total of 10 studies were included, involving 22 risk factors, of which 16 were included for further analysis. Meta analysis showed that cesarean section (OR=2.05, 95%CI: 1.71, 2.47, P=0.007), gestational diabetes (OR=1.17, 95%CI: 1.09, 1.27, P<0.001), eclampsia or preeclampsia (OR=1.88, 95%CI: 1.42, 2.49, P< 0.001), obesity (OR=1.19, 95%CI: 1.04, 1.86, P=0.028), twin or multiple pregnancy (OR=2.34, 95%CI: 1.46, 3.76, P<0.001), chronic heart disease (OR=3.59, 95%CI: 3.28, 3.92, P<0.001), and blood transfusion history (OR=3.20, 95%CI: 2.78, 3.68, P<0.001) were risk factors for VTE in pregnant women. CONCLUSIONS Existing evidence suggests that cesarean section, gestational diabetes, eclampsia or preeclampsia, obesity (body mass index ≥30 kg/m2), twin or multiple pregnancy, chronic heart disease, and blood transfusion history may be risk factors for VTE in pregnant women. In clinical practice, the evaluation and management of VTE should be strengthened, and a model for clinical prediction of VTE can be established to provide a reference for the prevention of VTE.
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Affiliation(s)
- Lianci He
- Chengdu Women's and Children's Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Jianhua Liu
- Chengdu Women's and Children's Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China -
| | - Rong Sun
- Chengdu Women's and Children's Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Li Qiu
- Chengdu Women's and Children's Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Ling Tang
- Chengdu Women's and Children's Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Yuan Gao
- Chengdu Women's and Children's Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
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Makowska A, Treumann T, Venturini S, Christ M. Pulmonary Embolism in Pregnancy: A Review for Clinical Practitioners. J Clin Med 2024; 13:2863. [PMID: 38792409 PMCID: PMC11121909 DOI: 10.3390/jcm13102863] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2024] [Revised: 05/06/2024] [Accepted: 05/08/2024] [Indexed: 05/26/2024] Open
Abstract
Diagnostic and therapeutic decision-making in pregnancy with suspected pulmonary embolism (PE) is challenging. European and other international professional societies have proposed various recommendations that are ambiguous, probably due to the unavailability of randomized controlled trials. In the following sections, we discuss the supporting diagnostic steps and treatments. We suggest a standardized diagnostic work-up in pregnant patients presenting with symptoms of PE to make evidence-based diagnostic and therapeutic decisions. We strongly recommend that clinical decisions on treatment in pregnant patients with intermediate- or high-risk pulmonary embolism should include a multidisciplinary team approach involving emergency physicians, pulmonologists, angiologist, cardiologists, thoracic and/or cardiovascular surgeons, radiologists, and obstetricians to choose a tailored management option including an interventional treatment. It is important to be aware of the differences among guidelines and to assess each case individually, considering the specific views of the different specialties. This review summarizes key concepts of the diagnostics and acute management of pregnant women with suspected PE that are supportive for the clinician on duty.
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Affiliation(s)
- Agata Makowska
- Emergency Department, Cantonal Hospital Lucerne, 6000 Lucerne, Switzerland; (S.V.); (M.C.)
- Cardiology, Hospital Centre of Biel, 2501 Biel, Switzerland
| | - Thomas Treumann
- Radiology, Cantonal Hospital Lucerne, 6000 Lucerne, Switzerland;
| | - Stefan Venturini
- Emergency Department, Cantonal Hospital Lucerne, 6000 Lucerne, Switzerland; (S.V.); (M.C.)
| | - Michael Christ
- Emergency Department, Cantonal Hospital Lucerne, 6000 Lucerne, Switzerland; (S.V.); (M.C.)
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Vuong ADB, Pham TH, Bui VH, Nguyen XT, Trinh NB, Nguyen YON, Le DKT, Nguyen PN. Successfully conservative management of the uterus in acute pulmonary embolism during cesarean section for placenta previa: a case report from Tu Du Hospital, Vietnam and literature review. Int J Emerg Med 2024; 17:14. [PMID: 38287235 PMCID: PMC10823749 DOI: 10.1186/s12245-024-00587-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2023] [Accepted: 01/12/2024] [Indexed: 01/31/2024] Open
Abstract
BACKGROUND Cardiopulmonary collapse is a catastrophic event in cesarean section, which leads to adverse outcomes for both the mother and the fetus. Pulmonary embolism is one of the rare etiologies of this entity. We herein reported the successful management of acute embolism pulmonary associated with cesarean delivery on a healthy pregnant woman at our tertiary referral hospital. CASE PRESENTATION A full-term pregnant woman hospitalized for planned cesarean delivery due to placenta previa without cardiorespiratory diseases. She was scheduled uneventfully for a planned cesarean section. After placental delivery, the patient spontaneously fell into cardiopulmonary collapse and her vital signs deteriorated rapidly. The obstetricians promptly completed the cesarean section and performed all procedures to prevent the PPH and preserve the uterus. At the same time, the anesthesiologists continued to carry out advanced heart-lung resuscitation in order to control her vital signs. After surgery, the multidisciplinary team assessed the patient and found a thrombus in her pulmonary circulation. Therefore, the patient was managed with therapeutic anticoagulation. The patient recovered in good clinical condition and was discharged after 2 weeks without any complications. CONCLUSIONS The diagnosis of acute pulmonary embolism is extremely difficult due to uncommon occurrence, sudden onset, and non-specific presentation. Awareness of this life-threatening pathology during cesarean delivery should be raised. Interdisciplinary assessment must be essentially established in this life-threatening condition. After the whole conventional management, uterine conservation may be acceptable where applicable. Further data is required to encourage this finding.
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Affiliation(s)
- Anh Dinh Bao Vuong
- Department of High-Risk Pregnancy, Tu Du Hospital, 284 Cong Quynh, Pham Ngu Lao Ward, District 1, Ho Chi Minh City, 71012, Vietnam
| | - Thanh Hai Pham
- Tu Du Clinical Research Unit (TD-CRU), Tu Du Hospital, Ho Chi Minh City, Vietnam
| | - Van Hoang Bui
- Integrated Planning Room, Tu Du Hospital, Ho Chi Minh City, Vietnam
| | - Xuan Trang Nguyen
- Department of High-Risk Pregnancy, Tu Du Hospital, 284 Cong Quynh, Pham Ngu Lao Ward, District 1, Ho Chi Minh City, 71012, Vietnam
| | - Ngoc Bich Trinh
- Department of High-Risk Pregnancy, Tu Du Hospital, 284 Cong Quynh, Pham Ngu Lao Ward, District 1, Ho Chi Minh City, 71012, Vietnam
| | - Yen Oanh Ngoc Nguyen
- Department of High-Risk Pregnancy, Tu Du Hospital, 284 Cong Quynh, Pham Ngu Lao Ward, District 1, Ho Chi Minh City, 71012, Vietnam
| | - Dang Khoa Tran Le
- Department of High-Risk Pregnancy, Tu Du Hospital, 284 Cong Quynh, Pham Ngu Lao Ward, District 1, Ho Chi Minh City, 71012, Vietnam
| | - Phuc Nhon Nguyen
- Department of High-Risk Pregnancy, Tu Du Hospital, 284 Cong Quynh, Pham Ngu Lao Ward, District 1, Ho Chi Minh City, 71012, Vietnam.
- Tu Du Clinical Research Unit (TD-CRU), Tu Du Hospital, Ho Chi Minh City, Vietnam.
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Luo X, Shan D, Zhang L, Wu Y, Li T, Ren Y, Hu Y. Incidence of maternal venous thromboembolism in China: A systematic review and meta-analysis. Int J Gynaecol Obstet 2023; 163:75-88. [PMID: 37069776 DOI: 10.1002/ijgo.14776] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2023] [Revised: 03/12/2023] [Accepted: 03/20/2023] [Indexed: 04/19/2023]
Abstract
BACKGROUND Venous thromboembolism (VTE) is one of the primary causes of maternal death. Although many studies have reported maternal VTE, no study has estimated the incidence of it in China. OBJECTIVES The aim of this work was to estimate the incidence of maternal VTE in China and to compare the risk factors for it. SEARCH STRATEGY The authors searched eight platforms and databases including PubMed, Embase, and Cochrane Library from inception to April 2022, with the search terms "venous thromboembolism" AND "puerperium (pregnancy)" AND "incidence" AND "China." SELECTION CRITERIA Studies provide data to calculate the incidence of maternal VTE among Chinese patients. DATA COLLECTION AND ANALYSIS The authors made a standardized table to collect data and calculated the incidence and 95% confidence intervals (CIs), founding source of heterogeneity by subgroup analysis and meta-regression and judging publication bias by funnel plot and Egger test. MAIN RESULTS The included 53 papers with a total sample size of 3 813 871 patients had 2539 cases of VTE, and the incidence of maternal VTE in China was 0.13% (95% CI, 0.11-0.16; P < 0.001). CONCLUSIONS The trend in the incidence of maternal VTE in China is stable. Cesarean section and advanced age are associated with a higher incidence of VTE.
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Affiliation(s)
- Xingrong Luo
- Department of Obstetrics and Gynecology, West China Second University Hospital, Sichuan University, Chengdu, China
- Key Laboratory of the Ministry of Education of Birth Defects and Related Maternal and Child Diseases, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Dan Shan
- Department of Obstetrics and Gynecology, West China Second University Hospital, Sichuan University, Chengdu, China
- Key Laboratory of the Ministry of Education of Birth Defects and Related Maternal and Child Diseases, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Lin Zhang
- Department of Obstetrics and Gynecology, West China Second University Hospital, Sichuan University, Chengdu, China
- Key Laboratory of the Ministry of Education of Birth Defects and Related Maternal and Child Diseases, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Yuxia Wu
- Key Laboratory of the Ministry of Education of Birth Defects and Related Maternal and Child Diseases, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Tao Li
- Department of Obstetrics and Gynecology, West China Second University Hospital, Sichuan University, Chengdu, China
- Key Laboratory of the Ministry of Education of Birth Defects and Related Maternal and Child Diseases, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Yu Ren
- Department of Obstetrics and Gynecology, Zigong Hospital of Woman and Children Healthcare, Zigong, Sichuan, China
| | - Yayi Hu
- Department of Obstetrics and Gynecology, West China Second University Hospital, Sichuan University, Chengdu, China
- Key Laboratory of the Ministry of Education of Birth Defects and Related Maternal and Child Diseases, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China
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Othman M, Pradhan A. Laboratory Testing of Hemostasis in Pregnancy: A Brief Overview. Methods Mol Biol 2023; 2663:111-125. [PMID: 37204707 DOI: 10.1007/978-1-0716-3175-1_7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/20/2023]
Abstract
Normal pregnancy is associated with significant physiological changes in the coagulation and fibrinolytic systems with an inclination toward a hypercoagulable state. This includes an increase in plasma levels of most clotting factors, a decrease in endogenous anticoagulants, and inhibition of fibrinolysis. Although these changes are critical in maintaining placental function and reducing postpartum hemorrhage, they may contribute to an increased risk of thromboembolism, particularly toward the end of pregnancy and during puerperium. Hemostasis parameters and the non-pregnant population reference ranges cannot be used in the assessment of bleeding or thrombotic complication risk during pregnancy, and pregnancy-specific information and reference ranges are not always available to support the interpretation of laboratory tests. This review aims to summarize the use of relevant hemostasis tests to promote evidence-based interpretation of laboratory test results as well as discuss challenges associated with testing during pregnancy.
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Affiliation(s)
- Maha Othman
- Department of Biomedical and Molecular Sciences, Queen's University, Kingston, ON, Canada.
- School of Baccalaureate Nursing, St. Lawrence College, Kingston, ON, Canada.
- Department of Clinical Pathology, School of Medicine, Mansoura University, Mansoura, Egypt.
| | - Anushka Pradhan
- Department of Biomedical and Molecular Sciences, Queen's University, Kingston, ON, Canada
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Pulmonary embolism in pregnancy and the puerperium. Best Pract Res Clin Obstet Gynaecol 2022; 85:96-106. [PMID: 35872145 DOI: 10.1016/j.bpobgyn.2022.06.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Accepted: 06/20/2022] [Indexed: 12/14/2022]
Abstract
Pulmonary embolism (PE) in pregnant women appears to be increasing. This could be related in part to improved health care allowing more women with risk factors to conceive, as well as increase in the high-risk groups which include pregnancies conceived on artificial reproductive technology, advancing maternal age, obesity, and caesarean deliveries. Prevention and early diagnosis with prompt effective treatment can reduce maternal mortality and improve pregnancy outcome, so that obstetricians should be on the lookout for venous thrombosis and PE, especially when in the majority of cases, risk factors only start to emerge or develop in the course of pregnancy and delivery. Management includes accurate diagnosis with ventilation/perfusion scan and CT pulmonary angiography, followed by effective anticoagulation and more aggressive measures such as thrombolysis as indicated, together with general supportive measures. Postpartum management should cover subsequent health issues, including breastfeeding, contraception, mood changes, and recurrence in subsequent pregnancies.
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Wu YY, Shan TT, Pan XT. Pulmonary Embolism After in vitro Fertilization and Cesarean Section: Two Case Reports and Brief Review of the Literature. Int J Womens Health 2022; 14:1489-1497. [PMID: 36317008 PMCID: PMC9617515 DOI: 10.2147/ijwh.s366355] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2022] [Accepted: 10/05/2022] [Indexed: 11/23/2022] Open
Abstract
This paper reports two cases of postpartum pulmonary embolism in Taicang First People's Hospital affiliated to Soochow University. They share many similarities in age, fertilization way, birthing method, incidence of pulmonary embolism, treatment and prognosis. The main purpose is to inspire the current maternal PTE risk assessment, diagnosis and treatment, as well as to explore the existing limitations and problems.
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Affiliation(s)
- Yu-Yan Wu
- Hematology Department, Taicang Hospital of Soochow University, Medical College of Soochow University, Taicang City, People’s Republic of China
| | - Tian-Tian Shan
- Hematology Department, Taicang Hospital of Soochow University, Medical College of Soochow University, Taicang City, People’s Republic of China
| | - Xiang-Tao Pan
- Hematology Department, Taicang Hospital of Soochow University, Medical College of Soochow University, Taicang City, People’s Republic of China,Correspondence: Xiang-Tao Pan, Hematology Department, Taicang hospital of Soochow University, Medical College of Soochow University, Taicang City, People’s Republic of China, Email
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Thachil R, Nagraj S, Kharawala A, Sokol SI. Pulmonary Embolism in Women: A Systematic Review of the Current Literature. J Cardiovasc Dev Dis 2022; 9:jcdd9080234. [PMID: 35893223 PMCID: PMC9330775 DOI: 10.3390/jcdd9080234] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Revised: 07/19/2022] [Accepted: 07/22/2022] [Indexed: 01/27/2023] Open
Abstract
Cardiovascular disease is the leading cause of death in women. Pulmonary embolism (PE) is the third most-common cause of cardiovascular death, after myocardial infarction (MI) and stroke. We aimed to evaluate the attributes and outcomes of PE specifically in women and explore sex-based differences. We conducted a systematic review of the literature using electronic databases PubMed and Embase up to 1 April 2022 to identify studies investigating PE in women. Of the studies found, 93 studies met the eligibility criteria and were included. The risk of PE in older women (especially >40 years of age) superseded that of age-matched men, although the overall age- and sex-adjusted incidence of PE was found to be lower in women. Risk factors for PE in women included age, rheumatologic disorders, hormone replacement therapy or oral contraceptive pills, pregnancy and postpartum period, recent surgery, immobilization, trauma, increased body mass index, obesity, and heart failure. Regarding pregnancy, a relatively higher incidence of PE has been observed in the immediate postpartum period compared to the antenatal period. Women with PE tended to be older, presented more often with dyspnea, and were found to have higher NT-proBNP levels compared to men. No sex-based differences in in-hospital mortality and 30-day all-cause mortality were found. However, PE-related mortality was higher in women, particularly in hemodynamically stable patients. These differences form the basis of future research and outlets for reducing the incidence, morbidity, and mortality of PE in women.
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Affiliation(s)
- Rosy Thachil
- Correspondence: ; Tel.: +718-918-5937; Fax: +(571)-376-6710
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