Pregnancy and Pulmonary Embolism

Dado, Christopher; Levinson, Andrew; Bourjeily, Ghada

doi:10.1016/j.ccm.2018.04.007

Cited by 58 publications

(70 citation statements)

References 88 publications

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“…Due to sudden onset of dyspnea, consciousness alteration and cardiovascular collapse during massage manipulation of the patient's leg, which was later proven to have pulmonary embolism and deep vein thrombosis, it is reasonable to conclude that the patient had undetected preexisting deep vein thrombosis, which was mechanically dislodged by the massage and travelled massively to both lungs, leading to a life threatening condition. However, differentiation from other causes of sudden dyspnea should be considered, including heart failure, ischemic heart, pericarditis, pneumonia, pneumothorax, exacerbation of chronic lung disease, and musculoskeletal pain [5][6][7][8]. For patients suspected of pulmonary embolism, tests including ECG, chest film, brain natriuretic peptide and troponin levels, and arterial blood gases are often helpful in differential diagnosis and management [5][6][7][8].…”

Section: Discussionmentioning

confidence: 99%

“…However, differentiation from other causes of sudden dyspnea should be considered, including heart failure, ischemic heart, pericarditis, pneumonia, pneumothorax, exacerbation of chronic lung disease, and musculoskeletal pain [5][6][7][8]. For patients suspected of pulmonary embolism, tests including ECG, chest film, brain natriuretic peptide and troponin levels, and arterial blood gases are often helpful in differential diagnosis and management [5][6][7][8]. However, a diagnosis of pulmonary embolism should be confirmed by CTA or magnetic resonance pulmonary angiogram.…”

Section: Discussionmentioning

confidence: 99%

“…Patients who are highly suspected of having this condition and unstable hemodynamics must be fully resuscitated, given anticoagulation and diagnostic imaging. For cases that remain unstable despite resuscitation, bedside echocardiography and compression ultrasonography with Doppler of the leg veins should be used to make a rapid diagnosis to justify the administration of potential life-saving treatment, including thrombolytic agents [5][6][7][8].…”

Section: Discussionmentioning

confidence: 99%

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Leg massage during pregnancy with unrecognized deep vein thrombosis could be life threatening: a case report

Sutham

Na-Nan

Paiboonsithiwong

et al. 2020

BMC Pregnancy Childbirth

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Background: Traditional massage seems to be safe but not entirely risk free, though serious adverse events are very rare. This report is aimed at illustrating a rare but fatal presentation of massive pulmonary embolism caused by leg massage and also to encourage both massage providers and pregnant women to be aware of undetected or subtle deep vein thrombosis, which could be a life threatening condition as a consequence of leg massage. Case presentation: A 25-year-old primigravid Thai woman underwent massage at a traditional massage shop at 25th week of gestation. Shortly after leg and foot massage, she had a sudden onset of dyspnea, followed by consciousness alteration, brief spastic-like convulsion, became unconscious and suffered a cardiac arrest. Basic life support (BLS) at the event scene as well as during transfer and advanced cardiovascular life support (ACLS) at the hospital were provided, resulting in successful resuscitation but persistent coma. Bedside echocardiography showed poor contractility of the dilated right ventricle, and pulmonary embolism was suspected. CT angiography (CTA) revealed multiple concentric intraluminal filling defects within the right and left pulmonary arteries, indicating massive pulmonary embolism. The fetus died in utero and spontaneous labor and vaginal delivery occurred. Conclusion: Leg massage in patients with deep vein thrombosis can dislodge thrombi, leading to life threatening pulmonary embolism, and should be contraindicated. Since pregnant women are at a higher risk of undetected or subtle thromboembolism, traditional massage in pregnant women should be contraindicated unless they are proven to have no such risk.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Leg massage during pregnancy with unrecognized deep vein thrombosis could be life threatening: a case report

Sutham

Na-Nan

Paiboonsithiwong

et al. 2020

BMC Pregnancy Childbirth

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“…PE is a leading cause of pregnancy-related death in the developed world. 2 The incidence of venous thromboembolism (VTE) is about 13 in 10,000 pregnancies, with half occurring before delivery and half in the postpartum period. The increased risk of VTE continues for 6-12 weeks postpartum.…”

Section: Case Discussion (Attending Discussion)mentioning

confidence: 99%

Fitting a Square Peg in a Round Hole: A Simple Case of Chest Pain

McLean

Beck-Esmay

2020

Clinical Practice and Cases in Emergency Medicine

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A 39-year-old female presents to the emergency department with chest pain and shortness of breath. Her electrocardiogram suggests ST-elevation myocardial infarction, but she has no atherosclerotic risk factors. She is gravida 4, para 4, and four weeks postpartum from uncomplicated vaginal delivery. She is diaphoretic and anxious, but otherwise her exam is unremarkable. Cardiac enzymes are markedly elevated and point-of-care echocardiogram shows inferolateral hypokinesis and ejection fraction of 50%. In this clinicopathological case, we explore a classically underappreciated cause of acute coronary syndrome in healthy young women.

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“…Management of PE is according to the advanced cardiac life support (ACLS) guidelines. 17 Massive PE is usually fatal though there have been few reports of successful use of fibrinolytics for massive, life-threatening PE. 18 • Amniotic fluid embolism (AFE): The most feared and deadly cause of arrest in parturient is AFE.…”

Section: Noncardiac Diseasesmentioning

confidence: 99%

Challenges of Cardiopulmonary Resuscitation during Pregnancy

2019

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Cardiac arrest, though rare, is the most feared complication in the pregnant woman as it involves two lives. Most arrests occur because of conditions that result from the pregnancy itself or from preexisting medical conditions exacerbated by the pregnancy. Prompt resuscitative efforts are crucial for favorable outcomes for the mother and fetus. The basic principles of resuscitation during pregnancy such as airway, breathing, and circulation are similar to the resuscitation in a cardiopulmonary arrest in any patient; however, certain modifications are necessary to account for the physiologic changes that occur during the pregnancy. Cardiopulmonary resuscitation (CPR) of the parturient should include uterine tilt or displacement to relieve the compression of the inferior vena cava and aorta by the gravid uterus, intubation using rapid sequence intubation with cricoid pressure, and timely perimortem cesarean section (PMCS). Ideally, the PMCS must be performed within 5 minutes of cardiac arrest if the pregnant woman does not have a return of spontaneous circulation, and resuscitation is deemed unsuccessful. The PMCS is performed if the gestational age is at least 20 weeks or the gravid uterus is evident. A high-quality CPR and multispecialty team approach, consisting of obstetricians, cardiologists, anesthesiologists, neonatologists, and nursing staff, is essential for survival.

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Pregnancy and Pulmonary Embolism

Cited by 58 publications

References 88 publications

Leg massage during pregnancy with unrecognized deep vein thrombosis could be life threatening: a case report

Leg massage during pregnancy with unrecognized deep vein thrombosis could be life threatening: a case report

Fitting a Square Peg in a Round Hole: A Simple Case of Chest Pain

Challenges of Cardiopulmonary Resuscitation during Pregnancy

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