2 articles
Venous thromboembolism is one of the leading causes of maternal morbidity and mortality. Pregnancy induces a hypercoagulable state as an adaptive mechanism to prevent hemorrhage during childbirth. These physiological changes significantly increase the risk of venous thromboembolism – by up to six-fold during pregnancy and up to 10-fold during the postpartum period compared to the non-pregnant population. Given these risks, proper identification of patients who may benefit from thromboprophylaxis is essential to improve maternal outcomes.
This manuscript reviews medical articles and current clinical guidelines on thromboprophylaxis in pregnancy and the puerperium, highlighting similarities, differences, and practical considerations in the management of at-risk patients. International guidelines developed to aid clinicians in venous thromboembolism risk stratification and prevention, including the Royal College of Obstetricians and Gynecologists, the American College of Obstetricians and Gynecologists, the American Society of Hematology, and the National Institute for Health and Care Excellence were analyzed.
The incidence of Venous thromboembolism ranges from 1 to 2 per 1,000, with up to 80% attributed to deep vein thrombosis cases occurring during the antepartum period, and 20%-25% being pulmonary embolism cases. In contrast, the incidence of pulmonary embolism is significantly higher after childbirth, with 40% to 60% of all pulmonary embolism cases occurring during the postpartum period. The impact of venous thromboembolism is not limited to mortality. Acute venous thromboembolism and the need for long-term anticoagulant therapy are associated with a significant clinical and psychological burden, while potential long-term sequelae, such as pulmonary hypertension and post-thrombotic syndrome, can have lifelong consequences. Ensuring thromboprophylaxis is essential, and the primary responsibility lies with the obstetrician. Ultimately, effective thromboprophylaxis is about balancing efficacy and safety between the need to prevent a potentially life-threatening event and the cost of an increased risk of bleeding.
Effective thromboprophylaxis during pregnancy and the puerperium remains a critical component of maternal care. The national protocol aims to assist healthcare professionals in identifying women at increased risk of venous thromboembolism during pregnancy, childbirth, and the postpartum period, and in making evidence-based decisions regarding the use of thromboprophylaxis and anticoagulant agents.
Pulmonary embolism is a life-threatening condition requiring prompt diagnosis. While contrast-enhanced computed tomography is the gold standard, its limited availability and associated risks necessitate complementary diagnostic tools. Recent studies suggest that combining multiple electrocardiographic abnormalities into a composite score may enhance diagnostic performance.
We conducted a prospective, cross-sectional study involving 200 patients with suspected pulmonary embolism admitted to two hospitals in the Republic of Moldova between 2022 and 2025. Among them, 168 had confirmed pulmonary embolism based on computed tomography pulmonary angiography, while 32 patients with similar symptoms but negative imaging served as the control group. All participants underwent a standard 12-lead electrocardiogram upon admission. A composite electrocardiographic score was applied, incorporating 10 criteria (e.g., sinus tachycardia, S1Q3T3 pattern, negative T waves in V1-V4, right bundle branch block, and right axis deviation), with a total score ranging from 0 to 12. Diagnostic thresholds were defined as follows: 0-3 low risk, 4-6 intermediate risk, and ≥7 high risk.
Electrocardiographic abnormalities such as negative T waves in V1–V4 (42.9% vs. 6.2%), atrial fibrillation (28.0% vs. 6.2%), and S1Q3T3 pattern (21.4% vs. 3.1%) were significantly more frequent in pulmonary embolism patients. A composite electrocardiographic score of ≥5 demonstrated excellent diagnostic performance: sensitivity 89.9%, specificity 93.8%, positive predictive value 98.7%, and overall accuracy 90.5%. The area under the ROC curve was 0.92, indicating strong discriminative ability. Among combinations of electrocardiographic findings, the pairing of S1Q3T3 with negative T waves in V1-V4 showed a statistically significant association with confirmed pulmonary embolism.
Our study confirms that a composite electrocardiographic score ≥5 is a highly effective, rapid, and noninvasive tool for identifying pulmonary embolism, improving early triage, particularly in emergency settings where imaging may be delayed. The model significantly outperforms isolated electrocardiographic findings and should be interpreted within a broader clinical context, including symptomatology and imaging when available.