Resumo

ZULU, N; ZAMPARINI, J; RHEMTULA, H  e  SCHAPKAITZ, E. Pregnancy-related pulmonary embolism: Clinical characteristics, management and outcomes in a South African academic hospital. SAMJ, S. Afr. med. j. [online]. 2026, vol.116, n.2, pp.28-34. ISSN 2078-5135.  https://doi.org/10.7196/SAMJ.2026.v116i2.3722.

BACKGROUND. Pulmonary embolism (PE) is a leading cause of death in pregnant and postpartum women. OBJECTIVE. To evaluate the clinical presentation, management and outcomes of pregnancy-related PE managed by a multidisciplinary team. METHODS. A retrospective review was conducted of pregnant and postpartum women diagnosed with PE between 2018 and 2024 at a tertiary hospital in Johannesburg, South Africa. Pretest probability scores (pregnancy-adapted YEARS and Geneva) were applied in a subgroup with D-dimers available. RESULTS. Seventy-seven women were included: 33 with antepartum and 44 with postpartum PE. The median (interquartile range) age was 29 (9) years, and most were of black African ethnicity. PE risk factors were present in 85% of antepartum and 96% of postpartum cases. Women with antepartum PE more frequently presented with chest pain, shortness of breath and palpitations (p<0.05). Pretest probability scores were assessed in a subgroup with D-dimers available. Based on the pregnancy-adapted YEARS and Geneva scores, imaging would have been required to rule out PE in 87.8% and 73.5% of cases, respectively. Computed tomography pulmonary angiography was the preferred diagnostic modality in 74.0%. Most women (97.4%) were treated as inpatients, and 57% required management in the intensive care and/or high care units. The median length of hospital stay was 14 (8) days. Low-molecular-weight heparin was the most frequently prescribed anticoagulant, with a median treatment duration of 3 (1) months. The live birth rate was 84.4%. One maternal death occurred due to sepsis, unrelated to venous thromboembolism. Antepartum/secondary postpartum major bleeding and primary postpartum major bleeding occurred in 6.5% and 3.9%, respectively. CONCLUSION. Pregnancy-associated PE managed by a multidisciplinary team was associated with favourable maternal and fetal outcomes.

Palavras-chave : pulmonary embolism; pregnancy; postpartum; maternal mortality; South Africa.

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