Pulmonary Embolism in the Post-partum Period: A Case Report

Irma Kartikasari, Syafarinah Nur Hidayah Akil

Abstract


Background: One well-known hypercoagulable state that raises the risk of venous thromboembolism is pregnancy and it is more common in cesarean delivery. Pulmonary embolisms are difficult to identify based solely on postpartum symptoms. Most of the symptoms are non-specific, therefore they are typically underdiagnosed throughout pregnancy and the postpartum period. Objective: This work presented information on the treatment of high-risk pulmonary embolism in the postpartum phase. Case presentation: This paper reported the case of a 33-year-old female, admitted to the emergency room for shortness of breath. Her personal history showed that she had just given birth to her sixth child by caesarian section a month ago and had a history of hysterectomy due to severe infection. Result: She suffered a high-risk pulmonary embolism in the post-partum period. It takes a strong index of suspicion to diagnose and treat patients in a timely manner. Conclusion: Echocardiography and Multislice Computerized Tomography are the best diagnostic methods. Venous thromboembolism prophylaxis should be taken into account, particularly in patients who have risk factors.


Keywords


pulmonary embolism, pregnancy, post-partum period

Full Text:

PDF

References


Al Dandan, O., Hassan, A., AbuAlola, H., Alzaki, A., Alwaheed, A., Alalwan, M., Al Shammari, M., AlShamlan, N., & Alsaif, H. S. (2020). Clinical and imaging profiles of pulmonary embolism: A single-institution experience. International Journal of Emergency Medicine, 13(1), 47. https://doi.org/10.1186/s12245-020-00303-y

Alsheef, M. A., Alabbad, A. M., Albassam, R. A., Alarfaj, R. M., Zaidi, A. R. Z., Al-Arfaj, O., & Abu-Shaheen, A. (2020). Pregnancy and Venous Thromboembolism: Risk Factors, Trends, Management, and Mortality. BioMed Research International, 2020, 4071892. https://doi.org/10.1155/2020/4071892

Anderson, F. A., & Spencer, F. A. (2003). Risk Factors for Venous

Thromboembolism. Circulation, 107(23_suppl_1), I–9. https://doi.org/10.1161/01.CIR.0000078469.07362.E6

Barnes, G. D. (2016). CHEST Guideline for Antithrombotic Therapy in VTE - American College of Cardiology. American College of Cardiology. https://www.acc.org/latest-in-cardiology/ten-points-to-remember/2016/03/02/15/45/antithrombotic-therapy-for-vte-disease

Bĕlohlávek, J., Dytrych, V., & Linhart, A. (2013). Pulmonary embolism, part I: Epidemiology, risk factors and risk stratification, pathophysiology, clinical presentation, diagnosis and nonthrombotic pulmonary embolism. Experimental & Clinical Cardiology, 18(2), 129–138.

Bikdeli, B., Lobo, J. L., Jiménez, D., Green, P., Fernández‐Capitán, C., Bura‐Riviere, A., Otero, R., DiTullio, M. R., Galindo, S., Ellis, M., Parikh, S. A., & Monreal, M. (2018). Early Use of Echocardiography in Patients With Acute Pulmonary Embolism: Findings From the RIETE Registry. Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease, 7(17), e009042. https://doi.org/10.1161/JAHA.118.009042

Chauhan, G., & Tadi, P. (2023). Physiology, Postpartum Changes. In StatPearls. StatPearls Publishing. http://www.ncbi.nlm.nih.gov/books/NBK555904/

Chen, A., Stecker, E., & A. Warden, B. (2020). Direct Oral Anticoagulant Use: A Practical Guide to Common Clinical Challenges. Journal of the American Heart Association, 9(13), e017559. https://doi.org/10.1161/JAHA.120.017559

Dabbouseh, N. M., Patel, J. J., & Bergl, P. A. (2019). Role of echocardiography in managing acute pulmonary embolism. Heart (British Cardiac Society), 105(23), 1785–1792. https://doi.org/10.1136/heartjnl-2019-314776

Dalen, J. E. (2006). New PIOPED Recommendations for the Diagnosis of Pulmonary Embolism. The American Journal of Medicine, 119(12), 1001–1002. https://doi.org/10.1016/j.amjmed.2006.06.034

Ewins, K., & Ní Ainle, F. (2019). VTE risk assessment in pregnancy. Research and Practice in Thrombosis and Haemostasis, 4(2), 183–192. https://doi.org/10.1002/rth2.12290

Heit, J. A., Kobbervig, C. E., James, A. H., Petterson, T. M., Bailey, K. R., & Melton, L. J. (2005). Trends in the Incidence of Venous Thromboembolism during Pregnancy or Postpartum: A 30-Year Population-Based Study. Annals of Internal Medicine, 143(10), 697–706. https://doi.org/10.7326/0003-4819-143-10-200511150-00006

Ho, Y.-K., Wang, C.-P., Wu, Y.-L., Lee, T.-H., Ying, T.-H., & Lee, M.-S. (2014). Pulmonary embolism after cesarean section and successful treatment with early application of extracorporeal membrane oxygenation system and anticoagulant agents. Taiwanese Journal of Obstetrics and Gynecology, 53(2), 273–275.

https://doi.org/10.1016/j.tjog.2013.04.041

Kearon, C., Akl, E. A., Ornelas, J., Blaivas, A., Jimenez, D., Bounameaux, H., Huisman, M., Cs, K., Ta, M., N, S., Sm, S., Jre, V., P, W., Sc, W., & L, M. (2016). Antithrombotic Therapy for VTE Disease: CHEST Guideline and Expert Panel Report. Chest, 149(2). https://doi.org/10.1016/j.chest.2015.11.026

Konstantinides, S. V., Meyer, G., Becattini, C., Bueno, H., Geersing, G.-J., Harjola, V.-P., Huisman, M. V., Humbert, M., Jennings, C. S., Jiménez, D., Kucher, N., Lang, I. M., Lankeit, M., Lorusso, R., Mazzolai, L., Meneveau, N., Ní Áinle, F., Prandoni, P., Pruszczyk, P., … ESC Scientific Document Group. (2020). 2019 ESC Guidelines for the diagnosis and management of acute pulmonary embolism developed in collaboration with the European Respiratory Society (ERS): The Task Force for the diagnosis and management of acute pulmonary embolism of the European Society of Cardiology (ESC). European Heart Journal, 41(4), 543–603. https://doi.org/10.1093/eurheartj/ehz405

Martinez Licha, C. R., McCurdy, C. M., Maldonado, S. M., & Lee, L. S. (2020). Current Management of Acute Pulmonary Embolism. Annals of Thoracic and Cardiovascular Surgery, 26(2), 65–71. https://doi.org/10.5761/atcs.ra.19-00158

Miranda-Bacallado, J., Izquierdo-Gómez, M. M., García-Niebla, J., Jiménez, J. J., Iribarren, J. L., Laynez-Cerdeña, I., & Lacalzada-Almeida, J. (2019). Role of echocardiography in a patient with suspected acute pulmonary embolism: A case report. Journal of Medical Case Reports, 13(1), 37. https://doi.org/10.1186/s13256-019-1994-y

Morris, J. M., Algert, C. S., & Roberts, C. L. (2010). Incidence and risk factors for pulmonary embolism in the postpartum period. Journal of Thrombosis and Haemostasis, 8(5), 998–1003. https://doi.org/10.1111/j.1538-7836.2010.03794.x

Oh, J. K., & Park, J.-H. (2023). Role of echocardiography in acute pulmonary embolism. The Korean Journal of Internal Medicine. https://doi.org/10.3904/kjim.2022.273

Raia-Barjat, T., Edebiri, O., & Chauleur, C. (2022). Venous Thromboembolism Risk Score and Pregnancy. Frontiers in Cardiovascular Medicine, 9, 863612. https://doi.org/10.3389/fcvm.2022.863612

Righini, M., Es, J., Exter, P., Roy, P.-M., Verschuren, F., Ghuysen, A., Rutschmann, O., Sanchez, O., Jaffrelot, M., Trinh-Duc, A., Le Gall, C., Moustafa, F., Principe, A., Houten, A., Wolde, M., Douma, R., Hazelaar, G., Erkens, P., Kralingen, K., & Le Gal, G. (2014). Age-Adjusted D-Dimer Cutoff Levels to Rule Out Pulmonary Embolism. JAMA : The Journal of the American Medical Association, 311, 1117–1124. https://doi.org/10.1001/jama.2014.2135

Righini, M., Robert-Ebadi, H., & Le Gal, G. (2017). Diagnosis of acute pulmonary embolism. Journal of Thrombosis and Haemostasis, 15(7), 1251–1261. https://doi.org/10.1111/jth.13694

Samuelsson, E., Hellgren, M., & Högberg, U. (2007). Pregnancy-related deaths due to pulmonary embolism in Sweden. Acta Obstetricia et Gynecologica Scandinavica, 86(4), 435–443. https://doi.org/10.1080/00016340701207500

Senst, B., Tadi, P., Basit, H., & Jan, A. (2023). Hypercoagulability. In StatPearls. StatPearls Publishing. http://www.ncbi.nlm.nih.gov/books/NBK538251/

Simpson, E. L., Lawrenson, R. A., Nightingale, A. L., & Farmer, R. D. T. (2001). Venous thromboembolism in pregnancy and the puerperium: Incidence and additional risk factors from a London perinatal database. British Journal of Obstetrics and Gynaecology, 108(1), 56–60. https://doi.org/10.1016/S0306-5456(00)00004-8

Song, B., Sun, Y., Liu, D., & Li, G. (2022). Acute pulmonary embolism right after caesarean section despite left ventricle dilatation: A case report and literature review [Preprint]. In Review. https://doi.org/10.21203/rs.3.rs-1515928/v1

Stein, P. D., Fowler, S. E., Goodman, L. R., Gottschalk, A., Hales, C. A., Hull, R. D., Leeper, K. V., Popovich, J., Quinn, D. A., Sos, T. A., Sostman, H. D., Tapson, V. F., Wakefield, T. W., Weg, J. G., & Woodard, P. K. (2006). Multidetector Computed Tomography for Acute Pulmonary Embolism. New England Journal of Medicine, 354(22), 2317–2327. https://doi.org/10.1056/NEJMoa052367

Tadesse, T. A., Kedir, H. M., Fentie, A. M., & Abiye, A. A. (2020). Venous Thromboembolism Risk and Thromboprophylaxis Assessment in Surgical Patients Based on Caprini Risk Assessment Model. Risk Management and Healthcare Policy, 13, 2545–2552. https://doi.org/10.2147/RMHP.S272852

Tan, T. C., Goh, C. M. Y., Tan, S. S. X., Tan, L. K., Yang, Y., & Lee, L. H. (2021). Epidemiology of pregnancy-associated pulmonary embolism in South Asian multi-ethnic country: Mortality trends over the last four decades. Journal of Obstetrics and Gynaecology Research, 47(1), 174–183. https://doi.org/10.1111/jog.14450

Tlamcani, I., Mouh, N. E., Amrani, K. E., & Hassani, M. A. (2018). Pregnancy and Hemostasis: From Physiology to Pathological States. Clinical Research in Hematology, 1(1).

Touhami, O., Marzouk, S. B., Bennasr, L., Touaibia, M., Souli, I., Felfel, M. A., Kehila, M., Channoufi, M. B., & Magherbi, H. E. (2018). Are the Wells Score and the Revised Geneva Score valuable for the diagnosis of pulmonary embolism in pregnancy? European Journal of Obstetrics & Gynecology and Reproductive Biology, 221, 166–171. https://doi.org/10.1016/j.ejogrb.2017.12.049

Turetz, M., Sideris, A. T., Friedman, O. A., Triphathi, N., & Horowitz, J. M. (2018). Epidemiology, Pathophysiology, and Natural History of Pulmonary Embolism. Seminars in Interventional Radiology, 35(2), 92–98. https://doi.org/10.1055/s-0038-1642036

White, R. H. (2003). The Epidemiology of Venous Thromboembolism. Circulation, 107(23_suppl_1), I–4. https://doi.org/10.1161/01.CIR.0000078468.11849.66

Worsley, D. F., & Alavi, A. (1995). Comprehensive Analysis of the Results of the PIOPED Study. The Journal of Nuclear Medicine, 36(12).

Wu, Y.-Y., Shan, T.-T., & Pan, X.-T. (2022). Pulmonary Embolism After in vitro Fertilization and Cesarean Section: Two Case Reports and Brief Review of the Literature. International Journal of Women’s Health, 14, 1489–1497. https://doi.org/10.2147/IJWH.S366355

Zubairi, A. B. S., Husain, S. J., Irfan, M., Fatima, K., Zubairi, M. A., & Islam, M. (2007). Chest radiographs in acute pulmonary embolism. Journal of Ayub Medical College, Abbottabad: JAMC, 19(1), 29–31.




DOI: http://dx.doi.org/10.30742/jikw.v13i2.3246

Refbacks

  • There are currently no refbacks.


Copyright (c) 2024 Irma Kartikasari; Syafarinah Nur Hidayah Akil

Creative Commons License
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.

Jurnal Ilmiah Kedokteran Wijaya Kusuma is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License

 

slot gacor slot gacor hari ini slot gacor 2025 demo slot pg slot gacor slot gacor