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Postpartum thrombolysis in a patient with cardiopulmonary arrest secondary to massive pulmonary embolism
Abstract Number: T 47
Abstract Type: Case Report/Case Series
The risk of postpartum venous thromboembolism increases 20-fold from baseline nonpregnant, nonpostpartum women, and remains one of the most common causes of maternal mortality in developed countries[2, 3]. Massive pulmonary embolism with cardiorespiratory collapse is, however, less frequent, and confronts us with unusual dilemmas in management. Mortality risk from pulmonary embolism with cardiogenic shock is as high as 70% [4-7]; it is, therefore, recommended to consider use of thrombolysis in pregnant women with life-threatening thromboembolism. No recommendations exist for the use of thrombolysis in the puerperium, but there are few anecdotal cases of it being used .
We present the case of a woman with a past medical history of thrombosis who was found in her room breathless and in pain, two days post cesarean section. Soon after, she suffered a cardiac arrest which necessitated cardiopulmonary resuscitation. Systemic thrombolysis with Alteplase in addition to standard Advanced Cardiovascular Life Support management of cardiac arrest proved effective in achieving return to spontaneous circulation. Subsequently, she experienced a massive hemorrhage, which was treated with multiple transfusions and a hysterectomy. Three days later, she was successfully extubated. Her only prolonged sequela was acute renal failure requiring dialysis. She had no neurological impairment and was breastfeeding her newborn on the same week.
1. Jackson, E., K.M. Curtis, and M.E. Gaffield, Risk of venous thromboembolism during the postpartum period: a systematic review. Obstet Gynecol, 2011. 117(3): p. 691-703.
2. McLintock, C., et al., Recommendations for the diagnosis and treatment of deep venous thrombosis and pulmonary embolism in pregnancy and the postpartum period. Aust N Z J Obstet Gynaecol, 2012. 52(1): p. 14-22.
3. James, A., Practice bulletin no. 123: thromboembolism in pregnancy. Obstet Gynecol, 2011. 118(3): p. 718-29.
4. Azarisman, S.M., et al., Immediate postpartum cardiorespiratory collapse: a management quandary. Blood Coagul Fibrinolysis, 2010. 21(6): p. 601-4.
5. Goldhaber, S.Z., L. Visani, and M. De Rosa, Acute pulmonary embolism: clinical outcomes in the International Cooperative Pulmonary Embolism Registry (ICOPER). Lancet, 1999. 353(9162): p. 1386-9.
6. Chunilal, S.D. and S.M. Bates, Venous thromboembolism in pregnancy: diagnosis, management and prevention. Thromb Haemost, 2009. 101(3): p. 428-38.
7. Samoukovic, G., T. Malas, and B. deVarennes, The role of pulmonary embolectomy in the treatment of acute pulmonary embolism: a literature review from 1968 to 2008. Interact Cardiovasc Thorac Surg, 2010. 11(3): p. 265-70.