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The Wells score is a clinical prediction rule used to classify patients suspected of having pulmonary embolism (PE) into risk groups by quantifying the pre-test probability. It is different than Wells score for DVT (deep vein thrombosis).
A V/Q scan confers a higher radiation dose to the fetus, while a CTPA confers a much higher radiation dose to the mother's breasts. A review from the United Kingdom in 2005 considered CTPA to be generally preferable in suspected pulmonary embolism in pregnancy because of higher sensitivity and specificity as well as a relatively modest cost. [7]
The Geneva score is a clinical prediction rule used in determining the pre-test probability of pulmonary embolism (PE) based on a patient's risk factors and clinical findings. [1] It has been shown to be as accurate as the Wells Score , and is less reliant on the experience of the doctor applying the rule. [ 2 ]
A blood test including platelets and a clotting screen should be performed prior to administration of anticoagulant regimens in pregnancy. [ 13 ] Subcutaneous tinzaparin may be given at doses of 175 units of antifactor Xa activity per kg, [ 13 ] based on prepregnancy or booking weight at approximately 16 weeks, and not the current weight. [ 13 ]
Pregnancy is associated with an increased risk of thrombosis of 2- to 7-fold. [25] This probably results from a physiological hypercoagulability in pregnancy that protects against postpartum hemorrhage. [26] This hypercoagulability in turn is likely related to the high levels of estradiol and progesterone that occur during pregnancy. [27]
A defect in the perfusion images requires a mismatched ventilation defect to indicate pulmonary embolism. [8] In the ventilation phase of the test, a gaseous radionuclides such as xenon-133, krypton-81m, or technetium-99m DTPA in an aerosol form is inhaled by the patient through a mouthpiece or mask that covers the nose and mouth. [10]
It is regarded as a highly sensitive and specific test for pulmonary embolism. [1] CTPA is typically only requested if pulmonary embolism is suspected clinically. If the probability of PE is considered low, a blood test called D-dimer may be requested. If this is negative and risk of a PE is considered negligible, then CTPA or other scans are ...
The pulmonary embolism rule-out criteria (PERC) helps assess people in whom pulmonary embolism is suspected, but unlikely. Unlike the Wells score and Geneva score , which are clinical prediction rules intended to risk stratify people with suspected PE, the PERC rule is designed to rule out the risk of PE in people when the physician has already ...