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Objective  To identify clinical features associated with pulmonary embolism (PE) diagnosis and determine the accuracy of decision rules and D‐dimer for diagnosing suspected  PE  in pregnant/postpartum women    Design  Observational cohort study augmented with additional cases.    Setting  Emergency departments and maternity units at eleven prospectively recruiting sites and maternity units in the United Kingdom Obstetric Surveillance System ( UKOSS )    Population  324 pregnant/postpartum women with suspected  PE  and 198 pregnant/postpartum women with diagnosed  PEMethods  We recorded clinical features, elements of clinical decision rules, D‐dimer measurements, imaging results, treatments and adverse outcomes up to 30 days    Main outcome measures  Women were classified as having  PE  on the basis of imaging, treatment and adverse outcomes by assessors blind to clinical features and D‐dimer. Primary analysis was limited to women with conclusive imaging to avoid work‐up bias. Secondary analyses included women with clinically diagnosed or ruled out  PE .    Results  The only clinical features associated with  PE  on multivariate analysis were age (odds ratio 1.06; 95% confidence interval 1.01–1.11), previous thrombosis (3.07; 1.05–8.99), family history of thrombosis (0.35; 0.14–0.90), temperature (2.22; 1.26–3.91), systolic blood pressure (0.96; 0.93–0.99), oxygen saturation (0.87; 0.78–0.97) and  PE ‐related chest x‐ray abnormality (13.4; 1.39–130.2). Clinical decision rules had areas under the receiver‐operator characteristic curve ranging from 0.577 to 0.732 and no clinically useful threshold for decision‐making. Sensitivities and specificities of D‐dimer were 88.4% and 8.8% using a standard threshold and 69.8% and 32.8% using a pregnancy‐specific threshold.    Conclusions  Clinical decision rules and D‐dimer should not be used to select pregnant or postpartum women with suspected  PE  for further investigation. Clinical features and chest x‐ray appearances may have counter‐intuitive associations with  PE  in this context.    Tweetable abstract  Clinical decision rules and D‐dimer are not helpful for diagnosing pregnant/postpartum women with suspected  PE

bjog: an international journal of obstetrics and gynaecology

The Di PEP  study: an observational study of the diagnostic accuracy of clinical assessment, D‐dimer and chest x‐ray for suspected pulmonary embolism in pregnancy and postpartum