Mrs Juliette Marks is a 32 year old woman who is 35 + 4 weeks pregnant. She has felt increasingly short of breath for the last 3 days and has right sided chest pain that is worse on taking a breath in. She has no cough and has not had haemoptysis.
This is her first child. She has had an uncomplicated pregnancy, all antenatal screening has been unremarkable and she is due for delivery in the midwife-led birthing unit. She has no significant past medical history and there is no significant family history. She lives with her husband and works as a secondary school teacher. She is a non-smoker, has no allergies and is not taking any medication.
Her initial observations are:
- Temperature: 37.2, HR 129bpm, RR 22/min, GCS 15, BP 138/90mmHg, BM 7.1mmol/L, Sats 90% on air
- A: airway clear
- B: tachypneoic, air entry bilaterally, no crepitations, wheeze or added sounds
- C: pulse rate elevated but of normal volume and character, warm peripherally, heart sounds normal, JVP not elevated. Capillary refill 2 seconds. Calves soft and non-tender with bilateral non-pitting ankle oedema.
- D: orientated to time, place and person. GCS E4 V5 M6. Pupils equal and reactive to light
- E: unremarkable abdominal examination, with gravid uterus and linea nigra
Question: What are the most appropriate investigations for suspected PE in pregnancy?
Question setter and expert: Dr Scott Rice, Radiologist at UCLH and Honorary Clinical Lecturer at UCL Medical School