Venous thromboembolism, abnormal echocardiography, and elevated D-dimer levels were independently associated with pulmonary embolism (PE) in postpartum patients. A retrospective study included 130 postpartum patients with PE and 192 without.
Among patients with PE, 96% had D-dimer levels exceeding the reference limit of 0.55 mg/L. Receiver operating characteristic analysis identified a 2.24 mg/L D-dimer threshold, yielding 90% specificity and 89% sensitivity for distinguishing PE from non-PE cases. Logistic regression confirmed three predictors: VTE (odds ratio [OR], 691), abnormal echocardiography (OR, 90), and elevated D-dimer (OR, 4).
Patients in the PE group were older compared with the non-PE group (median age, 33 years vs 31 years). Most patients in the non-PE group had not given birth prior to this pregnancy (76% vs 62%). Among patients in the PE group, 38% had at least one child before the current pregnancy, and 19% had an interbirth interval of one to 3 years.
The incidence of prophylactic anticoagulation, anemia, prenatal fever, emergency cesarean section, twins, postpartum acute infection, intraoperative bleeding, postpartum hemorrhage, and VTE was significantly higher in the PE group. Intraoperative hemorrhage occurred among 91% of patients in the PE group compared with 30% in the non-PE group. Postpartum hemorrhage occurred among 16% of patients in the PE group compared with 3% in the non-PE group.
Clinical manifestations were uncommon and occurred more often among patients with PE (12% vs 3%). Chest distress was reported among 9% and shortness of breath in 5%. Echocardiographic abnormalities were detected among 42% of patients in the PE group. Pulmonary emboli were located in the right lung in 50% of cases, in the left lung in 31%, and in both lungs in 19%.
The levels of creatinine, urea nitrogen, fibrinogen, total protein, and albumin in the PE group were significantly lower compared with the non-PE group, whereas total bilirubin, D-dimer, and B-type natriuretic peptide (BNP) were significantly higher.
All patients with PE received anticoagulation therapy. Nadroparin calcium was administered to 97% and enoxaparin to 3%. The median treatment duration was 10 days. Laboratory values improved following therapy, and maternal and infant survival rates were 100% and 99%, respectively.
The study evaluated postpartum patients treated at a single hospital. Researchers compared demographic, clinical, and laboratory data between those with and without PE. Stepwise logistic regression identified the factors that independently predicted PE.
The authors noted limitations, including the retrospective, single-center design and small sample size, which may limit generalizability. The temporal relationship between elevated D-dimer levels and PE onset could not be established.
Researchers concluded that postpartum patients with VTE or abnormal echocardiography findings may require closer monitoring. Elevated D-dimer levels above 2.24 mg/L could indicate possible PE and justify prompt imaging evaluation. “A significantly elevated D-dimer level (> 2.24 mg/L) serves as strong evidence of potential PE development, prompting physicians to prioritize imaging studies for early detection and confirmation,” wrote lead study author Min Cui, PhD, of Renji Hospital, School of Medicine, Shanghai Jiao Tong University, and colleagues. The authors noted that D-dimer should not be used as a stand-alone diagnostic tool but may support timely assessment and management decisions to improve outcomes.
The authors reported funding from the Science and Technology Commission of Shanghai Municipality, the Ministry of Science and Technology of the People's Republic of China, and Shanghai Jiao Tong University, School of Medicine, Renji Hospital. The authors reported no conflicts of interest.
Source: Frontiers in Medicine
