The diagnostic role of ventilation/perfusion scans versus computed tomography pulmonary angiography in obstetric patients investigated for pulmonary embolism at Wellington Hospital from 2010 to 2012.

AIM: To develop best practice clinical guidelines for the use of ventilation/perfusion (V/Q) scanning and computed tomography perfusion angiography (CTPA) in pregnancy and the postpartum period. METHOD: Retrospective analysis of the clinical findings and radiologic investigation for pulmonary embolism (PE) in obstetric women at Wellington Hospital from 2010 to 2012. RESULTS: Fifty-four women were investigated for PE with a V/Q scan or CTPA, including 29 antenatal women and 25 postnatal women. Eleven (37.9%) antenatal women had V/Q scans and 18 (62%) had CTPAs. Five (20%) postnatal women had V/Q scans, 19 (76%) had CTPAs and one (4%) had a V/Q scan followed by a CTPA. Three of the 54 women (5.6%) had a positive radiologic finding of PE (two by V/Q scan and one by CTPA). Four (22.2%) antenatal women and 5 (25%) postnatal women had a diagnosis made on CTPA, which was not seen on chest x-ray. CONCLUSION: This audit found that clinicians varied in their investigation of cases suspected of PE. We have proposed a clinical pathway for the investigation of PE in pregnancy and the postpartum period.