Pulmonary Embolism (PE) continues to carry substantial morbidity and mortality, with recent data suggesting a rising trend. Diagnosis during pregnancy and the postpartum period is particularly complex because clinical features often overlap with normal physiological changes. The pregnancy-adapted YEARS algorithm, which integrates clinical probability assessment with D-dimer testing, has been proposed as a strategy to rule out PE while avoiding thoracic imaging and unnecessary radiation. In this systematic review and meta-analysis, we investigated the diagnostic accuracy of the pregnancy-adapted YEARS algorithm in pregnant and postpartum women suspected of PE. Eligible studies were identified through comprehensive searches of PubMed, Scopus, and Cochrane and required the use of CT Pulmonary Angiography (CTPA) or Ventilation–Perfusion (V/Q) scanning as the diagnostic reference standard. The quality of the included studies was assessed using the QUADAS-2 tool. Data from the eligible trials were synthesized in Meta-Disc with a random-effects model. In total, five studies involving 1,036 participants were analyzed, all of which showed a low risk of bias. The pooled results indicated a sensitivity of 1.00 (95% CI: 0.94–1.00), a specificity of 0.12 (95% CI: 0.10–0.14), and an AUC of 0.72, suggesting that the algorithm performs well in excluding PE but is less reliable for confirming the diagnosis. These results indicate that the pregnancy-adapted YEARS algorithm may serve as a safe screening approach to minimize radiation exposure for both mother and fetus. However, confirmatory thoracic imaging remains necessary in patients with positive findings. © 2025 Indonesian Heart Association. All rights reserved.