Acute Pulmonary Embolism after Cesarean Section: A Case Report
| Other(s) | ||
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Tyrimo grupės vadovas / Research group head |
| Date |
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2021-05-21 |
Case Report IV
ISBN: 978-83-960390-9-5
Background: During the pregnancy, the risk of venous thromboembolism (VTE) is 5-10 times greater (compared to non-pregnant women) where it peaks during and shortly after delivery due to a hypercoagulable state. Moreover, the frequency of VTE increases with Cesarean section (CS), which could lead to a long-term deep vein insufficiency. Case report: We report the case of a 34-year-old obese woman with acute dizziness presented to the Emergency department (ED). The patient delivered a healthy baby via CS five weeks ago (sixth pregnancy and fifth labor). She was also diagnosed with acute thrombosis of right femoral and popliteal veins as well as acute thrombosis of left ulnar and cephalic veins two weeks after CS and was treated with LMWH twice daily at therapeutic doses. At ED, a head computed tomography scan (CT) ruled out any brain vascular pathology; abdominal ultrasound did not show gynecological pathology. Chest CT pulmonary angiography revealed multiple filling defects bilaterally within the pulmonary vasculature with acute pulmonary emboli and diagnosis of pulmonary embolism (PE) was established. Compression venous US showed thrombosis of the right saphenous and femoral vein as well as bilateral popliteal vein thrombosis. The patient was hospitalized and i.v. treatment with unfractionated heparin via continuous infusion pump was initiated later followed by warfarin administration. Unfortunately, the tests for thrombophilia were not performed. The patient was discharged from the hospital on the 14th day of hospitalization, taking 10mg of warfarin. She was seen 9 months later and had no recurrent PE, CTEPH nor deep vein thrombosis and anticoagulant was stopped. Conclusions: Women are at increased risk of VTE during pregnancy and the postpartum period. Use of appropriate medical imaging is essential when DVT or PE are suspected in this group of patients. Furthermore, testing for thrombophilia (including antiphospholipid antibodies and lupus anticoagulant) should be considered in patients as we presented.