In the United States,pulmonary embolism(PE)accounts for approximately 10%of all pregnancy related deaths.The standard treatment for a patient with high-risk PE is systemic thrombolysis.Systemic thrombolysis in pregnan...In the United States,pulmonary embolism(PE)accounts for approximately 10%of all pregnancy related deaths.The standard treatment for a patient with high-risk PE is systemic thrombolysis.Systemic thrombolysis in pregnancy is associated with the risk of maternal hemorrhage and fetal complications,including spontaneous abortion,preterm delivery,and fetal bleeding.Currently,there is limited evidence for a standardized approach for the treatment and management of intermediate-and high-risk PEs in pregnancy.A 36-year-old gravida 3 para 2002 woman at 31+1weeks of gestation with a history of deep vein thrombosis in her prior pregnancy presented with shortness of breath.A computed tomography angiogram revealed a large pulmonary embolus with a saddle component that extended into the bilateral upper and lower lobes and into the secondary and tertiary pulmonary branches.A subsequent bedside echocardiogram demonstrated a dilated right ventricle with severely reduced right ventricular systolic function.The patient was successfully treated with bilateral ultrasound-assisted catheter-directed thrombolysis.She subsequently delivered a healthy male infant at term.Reported cases of ultrasound-assisted catheter-directed thrombolysis in pregnant patients is limited.Our case demonstrates that localized thrombolysis is a viable treatment option for life-threatening PE in pregnancy.Catheterdirected thrombolysis can be efficacious in treating intermediate-and high-risk PEs in pregnancy while simultaneously reducing the risk of bleeding complications.展开更多
文摘In the United States,pulmonary embolism(PE)accounts for approximately 10%of all pregnancy related deaths.The standard treatment for a patient with high-risk PE is systemic thrombolysis.Systemic thrombolysis in pregnancy is associated with the risk of maternal hemorrhage and fetal complications,including spontaneous abortion,preterm delivery,and fetal bleeding.Currently,there is limited evidence for a standardized approach for the treatment and management of intermediate-and high-risk PEs in pregnancy.A 36-year-old gravida 3 para 2002 woman at 31+1weeks of gestation with a history of deep vein thrombosis in her prior pregnancy presented with shortness of breath.A computed tomography angiogram revealed a large pulmonary embolus with a saddle component that extended into the bilateral upper and lower lobes and into the secondary and tertiary pulmonary branches.A subsequent bedside echocardiogram demonstrated a dilated right ventricle with severely reduced right ventricular systolic function.The patient was successfully treated with bilateral ultrasound-assisted catheter-directed thrombolysis.She subsequently delivered a healthy male infant at term.Reported cases of ultrasound-assisted catheter-directed thrombolysis in pregnant patients is limited.Our case demonstrates that localized thrombolysis is a viable treatment option for life-threatening PE in pregnancy.Catheterdirected thrombolysis can be efficacious in treating intermediate-and high-risk PEs in pregnancy while simultaneously reducing the risk of bleeding complications.
