Pregnancy-associated pulmonary embolism during the peripartum period: An 8-year experience at a single center

Abstract

ObjectiveThe purpose of this study was to estimate the incidence, timing of onset, risk factors, and mortality rate of pregnancy-associated pulmonary embolism (PAPE).MethodsWe analyzed PAPE cases that occurred between January 2005 and December 2012 at Cheil General Hospital & Women's Healthcare Center. Those cases that were not confirmed by computed tomography scan or were confirmed as amniotic fuid embolisms were excluded. We analyzed various risk factors such as previous surgery, mode of delivery, maternal age, and obesity in PAPE.ResultsThere were 57,092 deliveries over 8 years. Of them, 13 cases (0.023%) were diagnosed with PAPE. All cases occurred in the postpartum period after cesarean delivery. There were no cases of PAPE after vaginal deliveries. Of the total cases, 10 cases (76.9%) were diagnosed in the early postpartum period within 48 hours. Eight cases (61.5%) had a history of previous surgery. There were 3 cases (23.1%) of multiple pregnancy and 3 cases (23.1%) of preterm delivery. No cases had a history of venous thromboembolism. Among 13 cases, 10 cases improved with only anticoagulation, 2 cases received surgical thrombectomy, and one case was maternal death.ConclusionOur results indicated that the incidence of PAPE was very low (0.023%) and occurred mainly in the postpartum period after cesarean section. However, its maternal mortality rate was significantly high (7.7%). Therefore, we suggest that immediate diagnosis and prompt treatment should be prioritized for improvement of PAPE patients' survival rate.

Epidemiology of pregnancy‐associated pulmonary embolism in South Asian multi‐ethnic country: Mortality trends over the last four decades

“…The low cumulative incidence may be truly low, consistent with a report from South Korea which described a much lower VTE rates of 0.82 per 10 000 deliveries as compared to the West 6 . However, subsequent paper shows that the incidence rate increased to 2.3 (per 10 000 deliveries), 14 underscoring the possibility of underdiagnosis from low awareness towards thrombotic diseases or low clinical suspicion due to perceived low incidence 15,16 …”

“…with a perinatal mortality rate of 44 per 1000 12 . Our neonatal outcomes are not adverse even though we had higher preterm births (37.5%) compared to another Korean study (23.1%) 14 . However, our sample size is too small to generalize and future larger scale studies are needed to determine the perinatal mortality rate of pregnancy‐associated PE.…”

“…where improved awareness and quality of detection of PE, albeit leads to more PE cases being diagnosed, but lower mortality rates due to improved prevention and treatment of PE 18 . However, a survey conducted in different countries in Asia found that the protocol for thromboprophylaxis in pregnancy is not well established in many Asian hospitals or routinely used by the doctors, 19 resulting in the high mortality rates we still see in other parts of Asia 7,14,20 …”

Venous Thromboembolism and Route of Delivery – Review of the Literature

“…8,9 It has been found that the incidence of VTE increases about 4-5 times in pregnant women and 20 times in the postpartum period. [5][6][7][9][10][11][12][13][14][15] This risk may be even higher: 1 study demonstrated a 60-fold increase in the risk of VTE in the first 3 months after delivery compared with non-pregnant women. 16 In developing countries, the incidence of VTE has increased, with a ratio of 1 case per every 16 pregnancies per year.…”

“…4,6,10,13,17 Given the high maternal mortality due to PTE, early diagnosis and treatment should be prioritized. 7…”