Summary:

 Pregnancy and the postpartum period are associated with an increased risk of venous thromboembolism (VTE). Over the past decade, new diagnostic algorithms have been established, combining clinical probability, laboratorytesting and imaging studies for the diagno-sis of deep vein thrombosis (DVT) and pulmonary embolism (PE) in the non-pregnant population. However, there is no such generally accepted algorithm for the diagnosis of pregnancy-associated VTE. Studies establishing clinical prediction rules have excluded pregnant women, and prediction scores currentlyin use have not been prospectivelyvalidated in pregnancyorduringthe postpartum period. D-dimers physiologically increase throughout pregnancy and peak at delivery, so a negative D-dimer test result, based on the reference values of non-pregnant subjects,becomes unlikely in the second and third trimesters. Imaging studies therefore play a major role in confirming suspected DVT or PE in pregnant women. Major concerns have been raised against radiologic imaging because of foetal radiation exposure, and doubts about the diagnostic value of ultrasound techniques in attempting to exclude isolated iliac vein thrombosis grow stronger as pregnancy progresses. As members of the WorkingGroup in Women's Health ofthe SocietyofThrombosis and Haemostasis (GTH), we summarise evidence from the available literature and aim to establish a more uniform strategyfordiagnosing pregnancy-associated VTE.

Key words:

Venous thromboembolism, pregnancy, diagnosis, ultrasonography, lung scintigraphy, computed tomography

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