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Fayad Al-Haimus on PE in Pregnancy: Some Common Pitfalls

Fayad Al-Haimus/LinkedIn

Dec 26, 2025, 13:43

Fayad Al-Haimus on PE in Pregnancy: Some Common Pitfalls

Fayad Al-Haimus, Adult Thrombosis Fellow at McMaster University, shared on LinkedIn:

”PE in pregnancy: Some common pitfalls

Whenever I’m covering thrombosis, I get a lot of calls about how to safely work up suspected PE in pregnancy.

A few key reminders that come up repeatedly:

1.Use the pregnancy-adapted YEARS criteria
Ask the 3 questions and then apply D-dimer correctly
0 YEARS criteria → D-dimer < 1000 ng/mL rules out PE
≥1 YEARS criterion → D-dimer < 500 ng/mL rules out PE

2.Consider bilateral leg ultrasound especially if there are symptoms
If proximal DVT is found → treat as VTE. No chest imaging needed

3.V/Q scan requires a normal chest X-ray
A normal CXR reduces the risk of a nondiagnostic V/Q. if CXR is abnormal then a V/Q scan is much less likely to be definitive for PE

4.Imaging is safe in pregnancy
Radiation doses are well below teratogenic thresholds:
V/Q scan: fetal dose ~0.1–0.7 mGy
CTPA: fetal dose ~0.01–0.1 mGy
CTPA has higher maternal breast dose, while V/Q has slightly higher fetal dose but both are considered safe when indicated. In practice, CTPA is often my first choice

5.Inconclusive imaging? Pick up the phone
If a study is nondiagnostic, talk directly with the radiologist: