Department of Obstetrics and Gynecology, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland.
Division of Angiology and Hemostasis, Department of Specialties of Medicine, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland.
J Thromb Haemost. 2017 Oct;15(10):1942-1950. doi: 10.1111/jth.13802. Epub 2017 Sep 12.
Essentials The evidence on how to manage life-threatening pregnancy-related pulmonary embolism (PE) is scarce. We systematically reviewed all available cases of (sub)massive PE until December 2016. Thrombolysis in such severe PE was associated with a high maternal survival (94%). The major bleeding risk was much greater in the postpartum (58%) than antepartum period (18%).
Background Massive pulmonary embolism (PE) during pregnancy or the postpartum period is a rare but dramatic event. Our aim was to systematically review the evidence to guide its management. Methods We searched Pubmed, Embase, conference proceedings and the RIETE registry for published cases of severe (submassive/massive) PE treated with thrombolysis, percutaneous or surgical thrombectomy and/or extracorporeal membrane oxygenation (ECMO), occurring during pregnancy or within 6 weeks of delivery. Main outcomes were maternal survival and major bleeding, premature delivery, and fetal survival and bleeding. Results We found 127 cases of severe PE (at least 83% massive; 23% with cardiac arrest) treated with at least one modality. Among 83 women with thrombolysis, survival was 94% (95% CI, 86-98). The risk of major bleeding was 17.5% during pregnancy and 58.3% in the postpartum period, mainly because of severe postpartum hemorrhages. Fetal deaths possibly related to PE or its treatment occurred in 12.0% of cases treated during pregnancy. Among 36 women with surgical thrombectomy, maternal survival and risk of major bleeding were 86.1% (95% CI, 71-95) and 20.0%, with fetal deaths possibly related to surgery in 20.0%. About half of severe postpartum PEs occurred within 24 h of delivery. Conclusions Published cases of thrombolysis for massive PE during pregnancy and the postpartum period suggest a high maternal and fetal survival (94% and 88%). In the postpartum period, given the high risk of major bleeding with thrombolysis, other therapeutic options (catheter [or surgical] thrombectomy, ECMO) may be considered if available.
妊娠相关的危及生命的肺栓塞（PE）的管理证据有限。我们系统地回顾了截至 2016 年 12 月所有可获得的（亚）大面积 PE 病例。严重 PE 中溶栓与高母体存活率（94%）相关。产后大出血风险明显高于产前（58% vs. 18%）。
背景：妊娠或产后期间的巨大肺栓塞（PE）是一种罕见但戏剧性的事件。我们的目的是系统地回顾证据以指导其管理。方法：我们在 Pubmed、Embase、会议记录和 RIETE 登记处搜索了使用溶栓、经皮或手术血栓切除术和/或体外膜氧合（ECMO）治疗的严重（亚/大面积）PE 的已发表病例，这些病例发生在妊娠期间或分娩后 6 周内。主要结局是母体存活率和大出血、早产、胎儿存活率和出血。结果：我们发现了 127 例严重 PE（至少 83%为大面积；23%有心搏骤停），至少采用了一种治疗方法。在 83 例接受溶栓治疗的妇女中，存活率为 94%（95%CI，86-98）。产后大出血风险为 17.5%，而产后为 58.3%，主要是因为产后严重出血。在接受治疗的妊娠期间，可能与 PE 或其治疗相关的胎儿死亡发生率为 12.0%。在 36 例接受手术血栓切除术的妇女中，母体存活率和大出血风险分别为 86.1%（95%CI，71-95）和 20.0%，手术相关的胎儿死亡发生率为 20.0%。大约一半的严重产后 PE 发生在分娩后 24 小时内。结论：发表的妊娠和产后期间溶栓治疗的大量 PE 病例表明母体和胎儿存活率高（94%和 88%）。在产后期间，鉴于溶栓治疗大出血风险高，如果有其他治疗选择（导管[或手术]血栓切除术、ECMO），可考虑采用。
