Thrombotic pulmonary embolism of inferior vena cava during caesarean section: A case report and review of the literature

Jiang, Lan; Liang, Weizhang; Yao, Yan; Wang, Shou-Ping; Li, Dai; Chen, Dunjin

doi:10.12998/wjcc.v10.i13.4226

Cited by 1 publication

(2 citation statements)

References 34 publications

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“…The data are even scarcer regarding the use of thrombolytic agents during CS. Jiang et al, reported a case of PE during CS in a 37-year-old parturient with rheumatic heart disease, G5P1, that was diagnosed with transthoracic echocardiogram (TTE) intraoperatively (6). She received general anaesthesia because of acute heart failure, pulmonary hypertension, and arrhythmia.…”

Section: Discussionmentioning

confidence: 99%

“…Pulmonary embolism (PE) represents the most severe and potentially lethal spectrum of VTE with a reported incidence of 1.03 per 10,000 deliveries (4). However, only limited cases of intraoperative acute PE have been reported in literature (3,(5)(6)(7)(8). Thrombolytic therapy, either intraoperative or in the immediate postpartum period with recombinant tissue plasminogen activator (rt-PA) is controversial because of high risk of massive bleeding (1,9).…”

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confidence: 99%

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Systemic Thrombolysis for Treatment of Acute Life-threatening Pulmonary Embolism During Cesarean Section Followed by Post-partum Rescue Hysterectomy: A Case Report and Review of the Literature

Karakosta

Evangelou

Flindris

et al. 2023

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Background/Aim: Acute pulmonary embolism during cesarean section is extremely rare and only a limited number of cases have been reported in literature. The aim of this study was to report a case of acute high risk pulmonary embolism during elective cesarean section treated with systemic thrombolysis and discuss the multidisciplinary management in both early recognition and prompt treatment. Case Report: A 39-year-old, G5P2, ASA II parturient presented for repeat cesarean section under general anesthesia. A sudden drop in end-tidal CO 2 after placenta delivery combined with significant hemodynamic instability after an uneventful intraoperative course was strongly indicative of pulmonary embolism. Urgent transthoracic ultrasound revealed a sizable thrombus in the inferior vena cava and the right atrium. Thrombolysis was carried out intraoperatively using recombinant tissue plasminogen activator, which was administered under continuous US monitoring until thrombus resolution. This resulted in significant bleeding that was treated in a stepwise manner beginning with implementation of massive transfusion protocol, Bakri balloon placement, and rescue hysterectomy several hours after the event. Follow-up was uneventful and she was discharged on the 12 th postoperative day. Conclusion: Though pregnancy is one of the major risk factors of the development of venous thromboembolism, acute intraoperative pulmonary embolism is extremely rare. Specific guidelines for the management of such cases are difficult to issue due to the paucity of relevant data. Thus, an individualized approach by a multidisciplinary team for diagnosis and intervention is mandated.Hemostatic alterations in normal pregnancy, characterized by marked increase in the procoagulant activity (FVII, FVIII, fibrinogen, FX, vWF), together with venous outflow obstruction due to uterus enlargement, predispose to a hypercoagulable state (1). These changes are maximal around term. The co-existence of other risk factors, such as prolonged immobilization, obesity, and cesarean section (CS) increase the risk for venous thromboembolism (VTE) in the obstetric population (2). Moreover, known inherited coagulation disorders complicate further the matter and require a multidisciplinary approach.Since pregnancy represents a hypercoagulable state, it is not surprising that VTE remains one of the leading causes of 498

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Section: Discussionmentioning

confidence: 99%