Thrombolysis for pulmonary embolism during pregnancy . About four cases

Pregnancy is correlated with a significant increase in the risk of pulmonary embolism (PE) given the physiological changes in fibrinolysis and mechanical stress induced by the pregnant uterus. Our goal is to demonstrate through four cases of massive bilateral PE occurred during pregnancy, the possibility of thrombolysis in pregnant women. We report the observation of four pregnant patients, between 28 and 38 years old and whose term varies between nine and 36 last menstrual period, hospitalized for serious PE complicated by cardiorespiratory arrest in one case and haemodynamic instability in other cases. Pulmonary angioscan was performed in three cases and transesophageal echocardiography in a patient with cardiogenic shock. Thrombolysis based on rtPA was performed in all cases, with a favorable evolution in 3 cases. No maternal or fetal complication has been observed during pregnancy or on follow-up that ranges from two to seven years. These findings underscore the safety and efficacy of thrombolysis, which remains the only life-saving therapeutic method immediately available in these severe forms of PE during pregnancy. The risk of bleeding induced by pregnancy should not be a contraindication.