Would ignoring pulmonary embolism (PE) symptoms in a pregnant patient be considered reckless malpractice?

Ignoring Pulmonary Embolism Symptoms in Pregnancy Constitutes Reckless Malpractice

Ignoring symptoms of pulmonary embolism (PE) in a pregnant patient would absolutely constitute reckless malpractice, as PE is the leading cause of pregnancy-related maternal death in developed countries and requires immediate investigation and management.

Why Ignoring PE Symptoms is Malpractice

• PE is the leading cause of pregnancy-related maternal death in developed countries 1
• The mortality rate for pregnant women with PE is approximately 3%, significantly higher than for non-pregnant women 2
• Maternal mortality from PE has been attributed specifically to delayed recognition and investigations 3

Critical Symptoms That Cannot Be Ignored

• Clinical features of PE in pregnancy include:

  • Pleuritic chest pain
  • Dyspnea (shortness of breath)
  • Tachycardia
  • Tachypnea
  • Cough
  • Sweating 4

• A dangerous pitfall is attributing these symptoms to normal pregnancy changes, as there is significant overlap between normal pregnancy symptoms and PE symptoms 4

Required Standard of Care

When PE is suspected in pregnancy, guidelines mandate:

1. Immediate diagnostic workup - The American Thoracic Society/Society of Thoracic Radiology emphasizes that clinical symptoms should never be relied upon to exclude PE in pregnancy 4

2. Structured diagnostic algorithm must be followed:

   • Apply modified Wells score (≥6 points is high risk)
   • Assess for DVT symptoms
   • Proceed with appropriate imaging 4

3. Initiate therapeutic anticoagulation if clinical suspicion remains high while awaiting definitive diagnosis 4

4. Imaging should not be delayed due to pregnancy - The European Society of Cardiology clearly states that concerns about radiation exposure are largely overruled by the hazards of missing a potentially fatal diagnosis 1

Legal Implications of Ignoring PE Symptoms

• Documented cases show that pregnant women who presented with dyspnea and syncope were ultimately diagnosed with pulmonary embolism, including saddle pulmonary embolus 5

• Case reports demonstrate that maternal death can occur suddenly and immediately after the onset of PE symptoms, highlighting the critical importance of prompt recognition 6

• The European Society of Cardiology guidelines explicitly state that diagnostic investigations "should aim for diagnostic certainty" in pregnant women with suspected PE 1

Conclusion

Ignoring symptoms of pulmonary embolism in a pregnant patient would constitute reckless malpractice because it violates clear medical guidelines, disregards the leading cause of maternal mortality, and fails to meet the standard of care that requires immediate investigation of suspected PE regardless of pregnancy status.

The evidence is unequivocal that prompt investigation and management of suspected PE in pregnancy is mandatory, and failure to do so directly endangers both maternal and fetal life.