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Massive pulmonary embolism in late pregnancy
D K Woodward1, R J Birks, K A Granger
1Department of Anaesthesia, Northern General Hospital, Sheffield, United Kingdom.
Canadian Journal of Anaesthesia = Journal Canadien D'Anesthesie
|November 18, 1998
Summary
This case study highlights the complex management of acute massive pulmonary embolism in a laboring woman. Successful outcomes were achieved through a multidisciplinary approach involving surgical pulmonary embolectomy and Cesarean section.
Area of Science:
- Cardiology
- Obstetrics
- Pulmonary Medicine
Background:
- Acute massive pulmonary embolism (PE) is a rare but life-threatening condition, particularly in pregnant or laboring women.
- Management requires a multidisciplinary approach, balancing maternal and fetal well-being.
Observation:
- A case of a 38-week gestation woman presenting with massive PE in early labor.
- Initial management included oxygen, intravenous heparin, and transfer to a cardiothoracic center.
- Pulmonary angiography confirmed massive PE; catheter-directed thrombolysis provided only temporary relief.
Findings:
- The patient underwent Cesarean section followed by surgical pulmonary embolectomy due to rapid deterioration.
- Both mother and child had a successful outcome.
- Individualized risk-benefit assessment of surgical embolectomy, thrombolysis, and mechanical disruption is crucial.
Implications:
- Management of acute massive PE in laboring women necessitates careful consideration of various treatment options.
- Co-location of cardiothoracic and obstetric facilities can significantly improve patient outcomes.
- This case underscores the importance of a coordinated, site-specific approach for rare obstetric emergencies.