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Poster Session 3

Category: Practice Management

Poster Session 3

(733) Development of a Clinical Scoring System to Rule Out Pulmonary Embolism in Pregnancy

Thursday, February 12, 2026

10:30 AM - 12:00 PM

Coauthor(s)

AR

Asaf Romano, MD (he/him/his)

OBGYN attending
Helen Schneider Hospital for Women, Rabin Medical Center
Petah Tikva, HaMerkaz, Israel

Submitting Author(s)

Chen Ben David, MD

Attendant
Obstetrics and Gynecology department, Rambam health care campus, Haifa, Israel
Haifa, HaZafon, Israel

Coauthor(s)

NS

Nitzan Dana Sela, MD

Obstetrics and Gynecology department, Haemek medical center
Haemek medical center, Afula, HaZafon, Israel
HI

Hagit Itzhak Kedem, MS

Medical faculty, Technion University
Medical faculty, Technion University, Haifa, HaZafon, Israel
GZ

Gil Zeevi, MD

Dr
Helen Schneider Hospital for Women, Rabin Medical Center
Petah Tikva, HaMerkaz, Israel
KE

Karin Edut, MD

Department of Obstetrics and Gynecology, Mayaney Hayeshua Medical Center, Bnei Barak; Israel
Department of Obstetrics and Gynecology, Mayaney Hayeshua Medical Center, Bnei Barak; Israel, HaMerkaz, Israel
SA

Suzan Abd Elgani, MD

Obstetrics and Gynecology, Haemek medical center
Obstetrics and Gynecology, Haemek medical center, HaZafon, Israel

Presenting Author(s)

BR

Bar Rosh, MD

Department of Obstetric and Gynecology, Rambam Health Care Campus
Rambam Health Care Campus, HaZafon, Israel

Coauthor(s)

SI

Solt Ido, MD

Director Maternal Fetal Medicine
Rambam Health Care Campus
haifa, Hefa, Israel
Yaniv Zipori, N/A

Rambam Health Care Campus
Rambam Health Care Campus, HaZafon, Israel

Objective:
To identify clinical predictors of pulmonary embolism (PE) in pregnant and postpartum women and develop a simple clinical risk scoring tool to stratify PE probability and reduce unnecessary imaging.

Study Design:
We conducted a retrospective multicenter cohort study across three university-affiliated hospitals (2013–2023). All pregnant or postpartum women evaluated for suspected PE. Demographics, clinical data, and outcomes were collected. Univariate and multivariate logistic regression analyses identified independent predictors. A weighted scoring system was constructed based on adjusted odds ratios (ORs), with cutoffs optimized to prioritize negative predictive value (NPV). ROC analysis was used to assess model performance.

Results:
Among 815 women evaluated for PE, 42 (5.2%) were diagnosed. Figure 1, demonstrates the multivariate regression model. The following variables were independently associated with PE: D-dimer ≥1500 ng/mL (OR 21.6, 95% CI 2.7–170.6), heart rate >100 bpm (OR 3.51, 95% CI 1.63–7.58), diabetes in pregnancy (OR 4.16, 95% CI 1.65–10.5), thrombophilia (OR 4.56, 95% CI 1.64–12.7), and infectious state (OR 4.06, 95% CI 1.41–11.65). Based on these findings, the Pulmonary Embolism in Pregnancy Scoring Index (PEPSI) was created (range 0–10 points). A score of ≤2 identified low-risk patients, with 82% specificity, 98.9% negative predictive value (NPV) and 16.6% positive predictive value (PPV). The the PPV for patients with a score of ≥ 6 reached 56.7%. The area under the ROC curve (AUC) was 0.887. As a result, we suggested to stratify patients into low (0–2), intermediate (3–5), and high (6–10) risk groups, with corresponding recommendations ranging from observation to immediate imaging and treatment initiation (table 1).

Conclusion:
The PEPSI score provides a clinically useful tool to identify pregnant patients at low risk for PE who may avoid unnecessary imaging. Further validation in prospective cohorts is warranted.