Massive pulmonary embolism with cardiac arrest in pregnancy: A case report

Abstract

Pregnant women are more prone to increased coagulability and, as such, venous thromboembolism (VTE) tends to occur 10 times more frequently in pregnant women than in the general population, with the rate ranging between 0.05% and 0.3% [1]. About 20% of maternal deaths are believed to be caused by VTE in the USA. Here, we report a case of a pregnant woman who developed cardiac arrest because of pulmonary embolism (PE) and subsequently underwent cesarean section. Case report A 39-year-old woman was referred to our hospital, at 23 weeks of gestation, for treatment of preterm labor. During hospitalization, she was placed on bed rest, with permission to stand and walk only for personal hygiene care and defecation without additional use of compression stockings. Four weeks later she suddenly complained of shortness of breath. Her D-dimer also increased to 5.2 mg/mL. Concerning the radiation exposure to the fetus, although agreeing to contrast computed tomography (CT) of the chest, agreement was not obtained for radiation to the uterus. We diagnosed PE. In the absence of evidence of deep vein thrombus of the lower extremities on venous echography, the patient was treated with continuous unfractionated heparin infusion. Activated partial thromboplastin time (APTT) was continuously administered 1.5-2.5 times as a guide. An inferior

Hypoglycemia as a cause of sudden cardiac arrest during cesarean delivery under spinal anesthesia: a case report and review of the literature

“…When occurring after delivery, it accounts for cardiac arrest and has an unfavorable prognosis. Release of compression by the gravid uterus after delivery facilitates the movement of thrombi formed in blood vessels in the lower body to the pulmonary circulation, resulting in pulmonary embolism and decrease of blood flow to the left ventricle, inducing cardiac arrest [8,9]. However, our patient had no respiratory complaints such as chest pain, cough, or hemoptysis, and the chest was clear, making the diagnosis less likely.…”

“…The causes of sudden cardiac arrest during spinal anesthesia are related to anesthetic procedures, surgical procedures, hypotension, primary cardiac problems, massive pulmonary embolism, hypoglycemia, pathophysiological changes during pregnancy, and other related factors [1][2][3][4][5][6][7][8][9][10]. Here, we tried to consider these as the possible differential diagnosis.…”

Features of pulmonary thromboembolism in women

“…Принято считать, что это объясняется использованием гормональных контрацептивов и беременностью в этот период жизни [9,10,22,23]. Поскольку беременность создает условия для реализации триады Вирхова, она предрасполагает к ТЭО и без иных ФР [24][25][26]. У беременных женщин происходит прогрессивное увеличение содержания прокоагуляционных факторов (VIII, VII, V, X, XII, VII, фибриногена), снижение активности антикоагулянтной системы за счет развития резистентности к активированному протеину С и снижения уровня протеина S на 40 %.…”