[Pulmonary thromboembolism in obstetrics]

Pulmonary embolism is a serious and sometimes mortal complication of pregnant and puerperal women. Pulmonary embolism diagnosis can be difficult. In Mexico, it causes between 2.5 and 16% of maternal mortality.

To estimate the incidence of pulmonary embolism, to identify most frequently risk factors that contribute to the presence of pulmonary embolism as an obstetrical complication and to determine clinical characteristics and specific diagnostic tests in hospitalized patients at the Hospital de Ginecoobstetricia, Centro Medico Nacional de Occidente, Instituto Mexicano del Seguro Social.

We conducted a cross-sectional study from January 1st 1997 to December 31st, 2002. We identified 30 patients with pulmonary embolism confirmed by ventilation-perfusion scan.

Incidence of 4.7 cases per 10,000 pregnancies was found. Most frequently, risk factors were varicose veins in lower extremities (0.045), previous thromboembolic event (0.030) and pre-eclampsia/eclampsia (0.05). Cesarean section was present in 85% of the cases with pulmonary embolism during puerperium. The most common clinical findings were: dyspnea (100%), chest pain (63%), tachycardia (93%) and tachypnea (93%). Sinus tachycardia (93%) and S1 Q3 T3 were the electrocardiogram findings most commonly observed. 83% of the patients showed abnormalities in chest radiography. 100% presented altered blood values. Mortality rate was of 6.6%.

Diagnosis of pulmonary embolism should be based on risk factors and clinical findings. Basic laboratory and scan are essential. Early diagnosis and treatment significantly reduce mortality rates.