Recombinant tissue plasminogen activator for massive pulmonary thromboembolism

Area of Science:

• Obstetrics and Gynecology
• Cardiology
• Critical Care Medicine

Background:

• Massive pulmonary thromboembolism (PTE) during pregnancy poses severe risks to both mother and fetus.
• Monteplase, a recombinant tissue plasminogen activator, is an effective treatment for PTE, but its use before delivery is less documented.

Observation:

• A 28-week pregnant patient experienced massive PTE, leading to cardiac arrest and intrauterine fetal demise.
• The patient received percutaneous cardiopulmonary support and monteplase, achieving thrombolysis within 30 minutes.
• Following treatment, the patient spontaneously delivered a stillborn and subsequently achieved hemostasis after several hours.

Findings:

• Successful thrombolysis with monteplase was achieved in a critically ill pregnant patient with massive PTE.
• The administration of monteplase did not preclude vaginal delivery or complicate postpartum hemostasis.
• This case demonstrates the feasibility of using thrombolytic therapy in late-stage pregnancy for massive PTE.

Implications:

• Thrombolytic therapy with monteplase can be a viable option for managing life-threatening PTE in pregnant patients, even in the third trimester.
• Careful monitoring and management can allow for successful thrombolysis and subsequent delivery.
• This approach may improve maternal survival rates in critical PTE cases during pregnancy.