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Truong RD, Cheyney S, Vo M, Garcia J, Desai NN, Kropf J, Hassanein H. Successful Treatment of Massive Pulmonary Embolism in Pregnancy with Catheter-Directed Embolectomy. AJP Rep 2024; 14:e140-e144. [PMID: 38736706 PMCID: PMC11087143 DOI: 10.1055/a-2299-4026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2023] [Accepted: 03/27/2024] [Indexed: 05/14/2024] Open
Abstract
Introduction Pulmonary embolism (PE) is associated with approximately 10.5% of maternal deaths in the United States. Despite heightened awareness of its mortality potential, there islittle data available to guide its management in pregnancy. We present the case of a massive PE during gestation successfully treated with catheter-directed embolectomy. Case Presentation A 37-year-old G2P1001 presented with a syncopal episode preceded by dyspnea and chest pain. Upon presentation, she was hypotensive, tachycardiac, and hypoxic. Imaging showed an occlusive bilateral PE, right heart strain, and a possible intrauterine pregnancy. Beta-human chorionic gonadotropin was positive. She was taken emergently for catheter-directed embolectomy. Her condition immediately improved afterward. Postprocedure pelvic ultrasound confirmed a viable intrauterine pregnancy at 10 weeks gestation. She was discharged with therapeutic enoxaparin and gave birth to a healthy infant at 38 weeks gestation. Conclusion Despite being the gold standard for PE treatment in nonpregnant adults, systemic thrombolysis is relatively contraindicated in pregnancy due to concern for maternal or fetal hemorrhage. Surgical or catheter-based thrombectomies are rarely recommended. Limited alternative options force their consideration, particularly in a hemodynamically unstable patient. Catheter-directed embolectomy can possibly bypass such complications. Our case exemplifies the consideration of catheter-directed embolectomy as the initial treatment modality of a hemodynamically unstable gestational PE.
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Affiliation(s)
- Rachel D. Truong
- Department of Internal Medicine, Orlando Regional Medical Center, Orlando, Florida
| | - Sarah Cheyney
- Department of Pulmonary and Critical Care Medicine, Orlando Regional Medical Center, Orlando, Florida
| | - Mai Vo
- Department of Pulmonary and Critical Care Medicine, Orlando Regional Medical Center, Orlando, Florida
| | - Joel Garcia
- Department of Interventional Cardiology, Orlando Regional Medical Center, Orlando, Florida
| | - Neeraj N. Desai
- Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, Winnie Palmer Hospital, Orlando, Florida
| | - Jacqueline Kropf
- Department of Hematology and Medical Oncology, Orlando Health Cancer Institute, Orlando, Florida
| | - Hatem Hassanein
- Department of Hematology and Medical Oncology, Orlando Health Cancer Institute, Orlando, Florida
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Javier RC, Singh PV, Shrestha J, Abdalla R, Narang P, Patel H, Yadav KP, Patel T, Fadiora OE, Shahzad H, Abbas K. Trends and Immediate Outcomes of Syncope During Pregnancy: A Narrative Review. Cureus 2023; 15:e49833. [PMID: 38107209 PMCID: PMC10725736 DOI: 10.7759/cureus.49833] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/02/2023] [Indexed: 12/19/2023] Open
Abstract
Pregnancy-related syncope presents special difficulties due to the rapid physiological changes that occur throughout gestation. This narrative review provides a thorough summary of the patterns and pregnancy outcomes secondary to syncope during pregnancy. There is an increase in syncope burden during pregnancy, and hence it is critical that medical professionals understand the significance of syncope during pregnancy. Syncope can have a negative impact on the health of the mother as well as the fetus. Therefore, this review summarizes data from studies on syncope in pregnancy. It includes observational studies, case reports, and review articles. Early detection and proper management are very important because pregnant women who experience cardiac syncope are at risk of unfavorable neonatal and maternal outcomes. The review reveals diverse trends in syncope incidence during pregnancy, emphasizing the need for a nuanced understanding of temporal variations. Risks of injury, uteroplacental insufficiency, psychological effects, interruptions in prenatal treatment, possible aggravation of pre-existing diseases, and lifestyle changes are examples of immediate maternal repercussions. Pregnancy-related syncope is a complex condition that affects the health of the mother and the fetus. The study stresses the need for careful clinical treatment due to the rapid results and the diversity in incidence patterns. The unique component of a possible relationship to the brain health of offspring justifies further investigation in this area.
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Affiliation(s)
| | - Parth Vikram Singh
- Department of Medicine, Indira Gandhi Government Medical College, Nagpur, IND
| | - Jeena Shrestha
- Department of Medicine, Jalalabad Ragib Rabeya Medical College, Sylhet, BGD
| | - Rasha Abdalla
- Department of Medicine, Shendi University, Shendi, SDN
| | - Punay Narang
- Department of Medicine, Spartan Health Sciences University, Vieux Fort, LCA
| | - Harshkumar Patel
- Department of Medicine, Pandit Dindayal Upadhyay (PDU) Medical College, Rajkot, IND
| | - Kameshwar P Yadav
- Department of Medicine, Universal College of Medical Sciences, Bhairahawa, NPL
| | - Tirath Patel
- Department of Medicine, American University of Antigua, St. John's, ATG
| | - Olatunji E Fadiora
- Department of Medicine, Windsor University School of Medicine, Cayon, KNA
| | - Humayun Shahzad
- Department of Medicine, Punjab Medical College, Faisalabad, PAK
| | - Kiran Abbas
- Department of Community Health Sciences, Aga Khan University, Karachi, PAK
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