Surveillance of pulmonary embolism in pregnancy (DiPEP)

Summary

Thromboembolic disease, including pulmonary embolism (PE) has been identified as the most important cause of direct maternal mortality in the UK, but can be difficult to diagnose. Pregnant and postpartum women with appropriately diagnosed and treated PE have a low risk of adverse outcomes, so accurate diagnosis can result in substantial benefits. However, the investigations used to diagnose PE (diagnostic imaging with VQ scanning or CT pulmonary angiography) carry risks of radiation exposure, reaction to contrast media and false positive diagnosis, are inconvenient for patients and incur costs for the health services. Clinicians therefore face a difficult choice when deciding how to investigate suspected PE in pregnant and postpartum women, between risking the potentially catastrophic consequences of missed diagnosis if imaging is withheld and risking iatrogenic harm to women without PE if imaging is over-used.

This study will use the UK Obstetric Surveillance System to identify all women with diagnosed pulmonary embolism (PE) in pregnancy and postpartum in the UK, and describe their characteristics and diagnostic investigations, and use this information in the wider (DiPEP) study estimating the diagnostic accuracy, effectiveness and cost-effectiveness of strategies for selecting pregnant or postpartum women with suspected PE for imaging.