Massive Pulmonary Embolism In A Postpartum Case of Caesarean Section A Case Report

Abstract

Introduction : The overall incidence of acute pulmonary embolism is 0.004% per year1; among post-partum women, the incidence of venous thromboembolism is approximately 3 to 7 every 10,000 deliveries, which is 15 to 35 times that of females of the same age who are not pregnant². Venous thromboembolism contributes to 20% of pregnancy-related mortalities. The highest risk is in the puerperium³. Thrombolysis is standard of care in pulmonary thromboembolism with shock and right ventricular hypokinesia^4-7, however, immediate postoperative state compels conventional treatment. Patients do well with anticoagulation and proper supportive treatment as illustrated in this case.
Case report : We report a case of a 34-year old female who developed sudden onset breathlessness while walking on the 2nd post-operative day of an uneventful caesarean section. She was dyspneic, cyanosed and in hypotension. CXR was normal, ECG showed S1Q3T3 pattern, and d-dimer was raised. CTPArevealed features of pulmonary embolism. Thrombolysis was contemplated but was abandoned in view of recent surgery. She received anticoagulation with Heparin (and later warfarin) and supportive care including intravenous fluids, oxygen and Dopamine and Doubutamine. She improved and was discharged after 10 days on warfarin anticoagulation.
Conclusion: Breathlessness in a patient in the post-operative period or pregnancy should lead to the possibility of pulmonary thromboembolism. PTE with hypotension or RV hypokinesia has a high mortality, merits thrombolysis plus anticoagulation. But patients with contraindication to thrombolysis should receive anticoagulation and standard supportive care. JMS 2016; 19(2):90-94.