Pregnancy-adapted YEARS algorithm and Geneva-based pathway

Clinical safety note: This tool is for stable pregnant or postpartum patients with suspected pulmonary embolism. Do not use a score to delay resuscitation, empiric anticoagulation, urgent imaging, or specialist consultation in an unstable, hypoxic, syncope-associated, or high-suspicion presentation.

Study setup

Patient status

Gestational timing

Primary pathway

D-dimer

YEARS thresholds are conventionally expressed as ng/mL FEU. Approximate conversion: FEU = 2 × DDU.

Immediate safety screen

Hemodynamic instability, persistent hypoxia, syncope with concern for PE, or severe cardiopulmonary compromise Anticoagulation or imaging decision requires urgent individualized review Chest X-ray abnormal or alternative pulmonary diagnosis suspected

Pregnancy-adapted YEARS

Clinical signs of deep vein thrombosis Hemoptysis PE is the most likely diagnosis

Compression ultrasound if DVT symptoms/signs

Rule-out threshold: <1000 ng/mL FEU if 0 YEARS items; <500 ng/mL FEU if 1 or more YEARS items.

Revised Geneva score

Previous PE or DVT 3 Surgery or fracture within 1 month 2 Active malignancy 2 Unilateral lower-limb pain 3 Hemoptysis 4 Pain on leg palpation and unilateral edema 4

Age over 65

Heart rate

Leg symptoms requiring CUS in pathway?

Compression ultrasound result

Traditional categories: 0–3 low, 4–10 intermediate, ≥11 high clinical probability. In pregnancy studies, this pathway was used mainly to guide D-dimer and imaging rather than to diagnose PE by score alone.

Notes for reporting

How to use

Enter the D-dimer, select the clinical findings, and the recommendation updates automatically. Use local units and confirm whether the laboratory reports FEU or DDU. Positive DVT ultrasound generally establishes VTE and may avoid chest imaging if the clinical question is PE management rather than anatomic confirmation.

Imaging prompt

If chest imaging is required, consider chest X-ray findings, availability, maternal body habitus, local imaging quality, and local radiology/nuclear medicine protocols. CTPA and V/Q approaches are both used in pregnancy; institutional protocols vary.

PERC and Wells caution

PERC and standard Wells criteria are not preferred stopping rules in pregnancy because they were not designed as pregnancy-specific rule-out tools and many symptoms overlap with normal pregnancy.

References

van der Pol LM, et al. Pregnancy-adapted YEARS algorithm for diagnosis of suspected pulmonary embolism. N Engl J Med. 2019;380:1139-1149.
Righini M, et al. Diagnosis of pulmonary embolism during pregnancy: a multicenter prospective management outcome study. Ann Intern Med. 2018;169:766-773.
Konstantinides SV, et al. 2019 ESC Guidelines for the diagnosis and management of acute pulmonary embolism. Eur Heart J. 2020;41:543-603.
Robert-Ebadi H, et al. Assessing the clinical probability of pulmonary embolism during pregnancy: data from the CT-PE Pregnancy study. J Thromb Haemost. 2022.