Background: Pregnancy and the postpartum period increase the risk of venous thromboembolism (VTE) including pulmonary embolism (PE), which is an important cause of maternal morbidity and mortality. While diagnostic strategies for suspected PE in pregnancy have evolved, postpartum patients remain underrepresented in research.

Objective: To evaluate diagnostic strategies and the prevalence of PE among postpartum patients presenting to an acute care setting with suspected PE, using data from a previously published individual patient data meta-analysis (IPDMA).

Methods: We analyzed 201 postpartum patients from six studies included in the IPDMA. Primary outcomes were PE prevalence and a description of the diagnostic tests used. Secondary outcomes included the performance of retrospectively calculated clinical decision rules (CDRs) including the revised Geneva score, pregnancy-adapted Geneva (PAG) score, and pulmonary embolism rule-out criteria (PERC), in combination with D-dimer testing and imaging.

Results: Among 201 postpartum patients with suspected PE, the prevalence was 6.0% (95% CI, 2.9%-12.3%). The revised Geneva and PERC CDRs performed similarly to previously published data. Notably, 29% (29/100, 95% CI, 21%-39%) of postpartum patients had a negative D-dimer result, and none of those with a negative result were diagnosed with PE, regardless of the CDR used.

Conclusions: The observed PE prevalence of 6.0% in this postpartum cohort underscores the need for evidence-based diagnostic pathways for physicians. Given that 29% of patients had a negative D-dimer and none were diagnosed with PE, diagnostic algorithms incorporating D-dimer testing could be applied in postpartum evaluations.