Diagnosis of Venous Thromboembolic disease (VTE) presenting as either deep vein thrombosis (DVT) or pulmonary embolism (PE) in pregnancy is difficult. Symptoms that are classically presenting features of DVT or PE such as leg swelling or shortness of breath can also be attributed to normal physiological changes of pregnancy. Clinical prediction models and biomarkers such as D-dimer assays that stratify risk and direct further investigation in the non-pregnant population have not been validated in pregnancy. Current investigation of the use of biomarkers and/or clinical prediction models for the diagnosis of VTE in pregnancy such as the 'Left" rule and DiPEP study has shown mixed results. Imaging modalities that are used in pregnancy have limitations due to changes in venous blood flow, increased cardiac output and radiation exposure to maternal breast tissue and the foetus that need careful consideration when being ordered and interpreted in the pregnant patient. Current algorithms exist for diagnosis of both DVT and PE in pregnancy however local guidelines should be developed that take into account issues such as accessibility to various imaging modalities.