Baracy Michael G, Olotu Olumide, Marchese Phillip, Gosselin Marc, Vengalil Shyla
Department of Obstetrics and Gynecology, Ascension St. John Hospital, Detroit, Michigan 48236, USA.
School of Medicine, St. Georges University, True Blue, Grenada.
Matern Fetal Med. 2021 Jun 22;4(3):229-232. doi: 10.1097/FM9.0000000000000104. eCollection 2022 Jul.
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 weeks 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. Catheter-directed thrombolysis can be efficacious in treating intermediate- and high-risk PEs in pregnancy while simultaneously reducing the risk of bleeding complications.
在美国，肺栓塞（PE）约占所有与妊娠相关死亡病例的10%。高危PE患者的标准治疗方法是全身溶栓。孕期全身溶栓与母体出血风险以及胎儿并发症相关，包括自然流产、早产和胎儿出血。目前，关于孕期中高危PE治疗与管理的标准化方法的证据有限。一名36岁、孕3产2（2002）的女性，妊娠31周，既往妊娠有深静脉血栓形成病史，出现呼吸急促。计算机断层血管造影显示一个巨大肺栓塞，伴有鞍状成分，延伸至双侧上下叶以及二级和三级肺分支。随后的床旁超声心动图显示右心室扩张，右心室收缩功能严重降低。该患者通过双侧超声辅助导管定向溶栓成功治疗。她随后足月分娩一名健康男婴。关于超声辅助导管定向溶栓治疗妊娠患者的报道病例有限。我们的病例表明，局部溶栓是治疗孕期危及生命的PE的一种可行治疗选择。导管定向溶栓在治疗孕期中高危PE时可有效，同时降低出血并发症风险。
