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O&G CasesAntenatal care — medical disorders in pregnancy

O&G Cases · Antenatal care — medical disorders in pregnancy

Suspected pulmonary embolism in late pregnancy — emergency management station

Emergency management station: suspected pulmonary embolism in late pregnancy. Tests the imaging choice, the immediate anticoagulation, the transition plan, the multidisciplinary response, and the postpartum prophylaxis. Includes assessor timeline, marking domains, assessor key and fail criteria.

resus4 min readVerification in progress

Target exams

FRANZCOGMRCOGABOG
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Target exams

FRANZCOGMRCOGABOG
Prompt
You are the registrar on the maternity assessment unit. A 33-year-old G2P1 at 34 weeks gestation presents with a six-hour history of sudden dyspnoea, right-sided pleuritic chest pain, and mild haemoptysis. She has a BMI of 38, an emergency caesarean in her first pregnancy, and a maternal aunt with a pulmonary embolism. On arrival: respiratory rate 28, oxygen saturation 93 per cent on room air, pulse 112 bpm, blood pressure 116/72 mmHg, loud pulmonary component of the second heart sound. The chest X-ray is normal. The assessor runs the clock and feeds you the scan results and the woman's responses.

Station brief

Format. Emergency management station, approximately 12 minutes. You are the registrar on the maternity assessment unit. A senior midwife and an obstetric SHO are with you; the consultant is in the building and can be at the bedside in three minutes. The assessor runs the clock and feeds you the scan results and the woman's responses. [1]

Candidate instruction. Lead the assessment and immediate management of an acutely dyspnoeic pregnant woman with suspected pulmonary embolism. Verbalise your working diagnosis, your differential, your actions, your drug orders with doses, and your communication with the team and the woman. [1][4]

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References7ShowHide
  1. [1]Bates SM, Rajasekhar A, Middeldorp S, et al. American Society of Hematology 2018 guidelines for management of venous thromboembolism: venous thromboembolism in the context of pregnancy Blood Adv, 2018.PMID 30482767
  2. [2]Leung AN, Bull TM, Jaeschke R, et al. An official American Thoracic Society/Society of Thoracic Radiology clinical practice guideline: evaluation of suspected pulmonary embolism in pregnancy Am J Respir Crit Care Med, 2011.PMID 22086989
  3. [3]Lamont MC, McDermott C, Thomson AJ United Kingdom recommendations for obstetric venous thromboembolism prophylaxis: Evidence and rationale Semin Perinatol, 2019.PMID 30935752
  4. [4]Chan WS Diagnosis of venous thromboembolism in pregnancy Thromb Res, 2018.PMID 28935434
  5. [5]American College of Obstetricians and Gynecologists' Committee on Practice Bulletins-Obstetrics ACOG Practice Bulletin No. 196: Thromboembolism in Pregnancy Obstet Gynecol, 2018.PMID 29939938
  6. [6]Bistervels IM, Buchmüller A, Wiegers HMG, et al. Intermediate-dose versus low-dose low-molecular-weight heparin in pregnant and post-partum women with a history of venous thromboembolism (Highlow study): an open-label, multicentre, randomised, controlled trial Lancet, 2022.PMID 36354038
  7. [7]Sultan AA, West J, Grainge MJ, et al. Development and validation of risk prediction model for venous thromboembolism in postpartum women: multinational cohort study BMJ, 2016.PMID 27919934
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