Compression Ultrasound Combined with Doppler Ultrasound Can Rule Out Blood Clots in Pregnant Women

The use of serial compression ultrasonographic scanning combined with Doppler ultrasound imaging appears to be an effective way to detect blood clots in the legs of pregnant women, according to new research.

The study’s findings were published January 14, 2012, in CMAJ (Canadian Medical Association Journal). With this new information, physicians, in all probability, can safely withhold anticoagulation therapy based on the results. This technique, recommended in women who are not pregnant to determine if there is deep vein thrombosis (DVT) in the legs, is also used in pregnant women but its safety has not been confirmed in this cohort study. Anticoagulation agents are used to treat blood clots during pregnancy and are safe for the fetus; improperly identifying blood clots during pregnancy can result in needless risks to a woman during and after pregnancy. It is therefore important to ascertain whether there is a clot.

Researchers evaluated data for 221 women who had symptoms of DVTs over an eight-year period, from August 2002 to September 2010, to determine whether compression ultrasonography with Doppler imaging is a safe diagnostic approach. They discovered that 7.7% of pregnant women with symptoms had DVT; 94% of these diagnoses were detected using serial compression ultrasonography with Doppler imaging of the iliac veins. These women were then treated with anticoagulants. One patient with normal test results was found to have a pulmonary embolism seven weeks later. The incidence of DVTs during follow-up was less than 1% (0.49%).

"Our strategy of serial compression ultrasonography combined with Doppler imaging of the iliac veins appears to reliably exclude clinically important deep vein thrombosis,” wrote Dr. Wee-Shian Chan, who is now at the department of medicine, Brithish Columbia Women’s Hospital and Health Center (Vancouver, BC, Canada), with coauthors.

“Our study highlights the importance of iliac vein visualization in symptomatic pregnant women. Because all of our cases of deep vein thrombosis were identified by initial imaging with compression ultrasonography and Doppler studies, it is unclear whether serial testing over a seven-day period is necessary,” stated the authors. More research, they stressed, will be required.

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BC Women’s Hospital and Health Center