Pregnancy Adapted Geneva Score: Scoring Criteria
The Pregnancy Adapted Geneva (PAG) Score consists of seven items and is specifically designed to assess the clinical probability of pulmonary embolism in pregnant women. 1
Scoring Criteria for the Pregnancy Adapted Geneva Score
| Variable | Points |
|---|---|
| Age ≥40 years | 1 |
| Heart rate >110 beats per minute | 1 |
| Previous history of DVT/PE | 1 |
| Surgery or fracture within 4 weeks | 1 |
| Unilateral lower limb pain | 1 |
| Hemoptysis | 1 |
| Pain on deep venous palpation and unilateral edema | 1 |
Risk Stratification Based on Total Score
- Low Risk: Score indicates 2.3% prevalence of PE
- Intermediate Risk: Score indicates 11.6% prevalence of PE
- High Risk: Score indicates 61.5% prevalence of PE 2
Clinical Application
The PAG Score was developed to address the limitations of standard clinical prediction rules when applied to pregnant women. The traditional Geneva score and Wells score include items like age >65 years and cancer, which are rarely present in pregnant women 2. The PAG Score shows superior discriminative power compared to these standard scoring systems, with an area under the curve of 0.795 compared to 0.684 for the original Geneva score 2.
Advantages of the PAG Score
- Fully objective decision rule without subjective clinical judgment
- Specifically designed for pregnant women
- Easy to compute at bedside
- Higher discriminative power than standard scoring systems in pregnant population
Diagnostic Pathway After Scoring
After applying the PAG Score:
- For patients with signs/symptoms of DVT, bilateral compression ultrasound of lower extremities should be performed first
- If ultrasound is positive, begin anticoagulation
- If ultrasound is negative or not indicated, proceed with pulmonary vascular studies
- Obtain chest X-ray first, then:
- If CXR is normal: proceed to lung scintigraphy (V/Q scan)
- If CXR is abnormal: proceed to CT pulmonary angiography 1
Important Considerations
- D-dimer testing is not recommended for excluding PE in pregnant women due to poor specificity and inadequate sensitivity 1
- The PAG Score should guide the diagnostic approach but should not replace clinical judgment in unstable patients
- Empiric anticoagulation should be considered for unstable patients while awaiting diagnostic test results 1
Unlike the original Geneva score or revised Geneva score which have different point weights for different variables 3, the PAG Score follows a simplified approach similar to the simplified Geneva score, assigning one point to each variable (except for heart rate >110 bpm) 2, 4.