The Impact of Pregnancy on the Evaluation of Chest Pain and Shortness of Breath in the Emergency Department

Background: Pregnant patients are at an increased risk for severe morbidity and mortality when compared to the general population. Imaging studies have become an integral part of the work-up for patients who present to the emergency department. However, lack of clear guideline has led to confusion regarding the appropriate indications and protocols for examining pregnant patients. Objective: To investigate the comparative rates of imaging studies between pregnant and non-pregnant female patients who presented for emergent evaluation of chest pain and shortness of breath. Study Design: All reproductive age females presenting to the emergency department at an academic teaching institution with a chief complaint of "chest pain" or "shortness of breath" from 2010 to 2015 were identified. Cohorts were divided based on pregnancy status and chief complaint. Utilization rates of imaging studies were compared between cohorts. Results: Over the study period 4,834 women were included. One hundred and seventy-four were pregnant. Pregnant patients with "chest pain" or "shortness of breath" were significantly more likely to undergo a venous duplex, but less likely to undergo a chest X-ray as compared to non-pregnant patients. There was no difference in the rates of chest computed tomography (CT) imaging or magnetic resonance imaging (MRI) based on pregnancy status in our data set. Conclusion: Imaging studies are an integral adjunct for evaluation in patients reporting "chest pain" and "shortness of breath." Pregnancy places patients at an increased risk of severe sequelae requiring prompt diagnosis to prevent harm to the mother and fetus. American College of Obstetrics and Gynecology (ACOG) Committee Opinion 656 clearly states that, with few exceptions, radiography should not be withheld from pregnant patients. This study suggests that pregnant patients are significantly less likely to undergo radiography, which could place them at increased risk for delayed diagnosis and treatment.