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Vuong ADB, Pham TH, Bui VH, Nguyen XT, Trinh NB, Nguyen YON, Le DKT, Nguyen PN. Successfully conservative management of the uterus in acute pulmonary embolism during cesarean section for placenta previa: a case report from Tu Du Hospital, Vietnam and literature review. Int J Emerg Med 2024; 17:14. [PMID: 38287235 PMCID: PMC10823749 DOI: 10.1186/s12245-024-00587-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2023] [Accepted: 01/12/2024] [Indexed: 01/31/2024] Open
Abstract
BACKGROUND Cardiopulmonary collapse is a catastrophic event in cesarean section, which leads to adverse outcomes for both the mother and the fetus. Pulmonary embolism is one of the rare etiologies of this entity. We herein reported the successful management of acute embolism pulmonary associated with cesarean delivery on a healthy pregnant woman at our tertiary referral hospital. CASE PRESENTATION A full-term pregnant woman hospitalized for planned cesarean delivery due to placenta previa without cardiorespiratory diseases. She was scheduled uneventfully for a planned cesarean section. After placental delivery, the patient spontaneously fell into cardiopulmonary collapse and her vital signs deteriorated rapidly. The obstetricians promptly completed the cesarean section and performed all procedures to prevent the PPH and preserve the uterus. At the same time, the anesthesiologists continued to carry out advanced heart-lung resuscitation in order to control her vital signs. After surgery, the multidisciplinary team assessed the patient and found a thrombus in her pulmonary circulation. Therefore, the patient was managed with therapeutic anticoagulation. The patient recovered in good clinical condition and was discharged after 2 weeks without any complications. CONCLUSIONS The diagnosis of acute pulmonary embolism is extremely difficult due to uncommon occurrence, sudden onset, and non-specific presentation. Awareness of this life-threatening pathology during cesarean delivery should be raised. Interdisciplinary assessment must be essentially established in this life-threatening condition. After the whole conventional management, uterine conservation may be acceptable where applicable. Further data is required to encourage this finding.
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Affiliation(s)
- Anh Dinh Bao Vuong
- Department of High-Risk Pregnancy, Tu Du Hospital, 284 Cong Quynh, Pham Ngu Lao Ward, District 1, Ho Chi Minh City, 71012, Vietnam
| | - Thanh Hai Pham
- Tu Du Clinical Research Unit (TD-CRU), Tu Du Hospital, Ho Chi Minh City, Vietnam
| | - Van Hoang Bui
- Integrated Planning Room, Tu Du Hospital, Ho Chi Minh City, Vietnam
| | - Xuan Trang Nguyen
- Department of High-Risk Pregnancy, Tu Du Hospital, 284 Cong Quynh, Pham Ngu Lao Ward, District 1, Ho Chi Minh City, 71012, Vietnam
| | - Ngoc Bich Trinh
- Department of High-Risk Pregnancy, Tu Du Hospital, 284 Cong Quynh, Pham Ngu Lao Ward, District 1, Ho Chi Minh City, 71012, Vietnam
| | - Yen Oanh Ngoc Nguyen
- Department of High-Risk Pregnancy, Tu Du Hospital, 284 Cong Quynh, Pham Ngu Lao Ward, District 1, Ho Chi Minh City, 71012, Vietnam
| | - Dang Khoa Tran Le
- Department of High-Risk Pregnancy, Tu Du Hospital, 284 Cong Quynh, Pham Ngu Lao Ward, District 1, Ho Chi Minh City, 71012, Vietnam
| | - Phuc Nhon Nguyen
- Department of High-Risk Pregnancy, Tu Du Hospital, 284 Cong Quynh, Pham Ngu Lao Ward, District 1, Ho Chi Minh City, 71012, Vietnam.
- Tu Du Clinical Research Unit (TD-CRU), Tu Du Hospital, Ho Chi Minh City, Vietnam.
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Vyas N, Poonja N, Shetty B, Rai S. Pulmonary thromboembolism and its complications in a patient in labour. BMJ Case Rep 2022; 15:e248469. [PMID: 35232745 PMCID: PMC8889244 DOI: 10.1136/bcr-2021-248469] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/08/2022] [Indexed: 11/04/2022] Open
Abstract
Venous thromboembolic event in pregnancy is a rare but dreaded complication. When it occurs in labour, it presents with sudden severe fetal distress and maternal haemodynamic compromise. We present to you a case where in patient was taken up for emergency caesarean section for severe fetal distress. Intraoperative ECG showed right heart strain. Hence, an immediate bedside echocardiography was done in medical intensive care unit and it picked up a swirling thrombus in right atrium which immediately got dislodged to pulmonary vessels. Postcaesarean, we faced challenge of controlling active bleeding from atonic uterus with non-surgical techniques (Bakri balloon tamponade and uterine artery embolisation) before considering anticoagulation therapy for pulmonary embolism. The patient recovered well after anticoagulation treatment.
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Affiliation(s)
- Neetha Vyas
- OBG, KS Hegde Medical Academy, Mangalore, Karnataka, India
| | - Neetha Poonja
- OBG, KS Hegde Medical Academy, Mangalore, Karnataka, India
| | - Balika Shetty
- OBG, KS Hegde Medical Academy, Mangalore, Karnataka, India
| | - Supriya Rai
- OBG, KS Hegde Medical Academy, Mangalore, Karnataka, India
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Rodriguez D, Jerjes-Sanchez C, Fonseca S, Garcia-Toto R, Martinez-Alvarado J, Panneflek J, Ortiz-Ledesma C, Nevarez F. Thrombolysis in massive and submassive pulmonary embolism during pregnancy and the puerperium: a systematic review. J Thromb Thrombolysis 2021; 50:929-941. [PMID: 32347509 DOI: 10.1007/s11239-020-02122-7] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Thrombolysis in high-risk pulmonary embolism (PE) patients is recommended worldwide; however, the evidence for thrombolysis during pregnancy and the immediate puerperium remains unclear. We conducted a systematic review from 1950 to 2019 through PubMed, Ovid/Willey, and Cochrane Library to assess the safety and effectiveness of thrombolysis during pregnancy and the immediate puerperium. Additionally, we characterized the clinical presentation, risk stratification, and diagnostic approach. We have communicated our results according to the PRISMA statement. We collected 141 records and, after critical assessment, included 47 case reports of 54 patients, including 43 and 11 patients during pregnancy and puerperium, respectively. During pregnancy, alteplase was the most frequent systemic thrombolytic agent used (67%), but only nine patients received the approved FDA regimen. With catheter-directed thrombolysis, low-dose thrombolytics and fragmentation were the most common regimens. Major bleeding occurred in 18% of cases, but there was no intracranial bleeding. One maternal death occurred secondary to refractory cardiogenic shock. Fetal mortality was 20%. During the immediate puerperium, nine patients received "off-label" first-, second-, and third-generation thrombolytic regimens, and four cases underwent catheter-directed thrombolysis. We observed nine major bleeding events, seven of which were from the uterine location and none of which were intracranial. In conclusion, overall, these data do not suggest prohibitive risk associated with thrombolysis for PE in pregnancy. Management of massive and high-risk submassive PE in pregnancy should be individualized to each patient. In the data presented, no fatal bleeding or intracranial bleeding was observed. Finally, future efforts should systematically collect and report data on high-risk PE in pregnancy and peripartum patients to improve the evidence-base clinical practice.
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Affiliation(s)
- David Rodriguez
- Escuela de Medicina y Ciencias de La Salud, Tecnologico de Monterrey, Monterrey, Nuevo Leon, Mexico
- Centro de Investigacion Biomedica del Hospital Zambrano Hellion, TecSalud, San Pedro Garza García, Nuevo Leon, Mexico
- Instituto de Cardiología y Medicina Vascular, TecSalud, San Pedro Garza García, Nuevo Leon, Mexico
| | - Carlos Jerjes-Sanchez
- Escuela de Medicina y Ciencias de La Salud, Tecnologico de Monterrey, Monterrey, Nuevo Leon, Mexico.
- Centro de Investigacion Biomedica del Hospital Zambrano Hellion, TecSalud, San Pedro Garza García, Nuevo Leon, Mexico.
- Instituto de Cardiología y Medicina Vascular, TecSalud, San Pedro Garza García, Nuevo Leon, Mexico.
- Hospital Zambrano Hellion, Batallón de San Patricio 112, Real San Agustin, San Pedro Garza Garcia, Nuevo Leon, 66278, Mexico.
| | - Sugely Fonseca
- Internal Medicine, Hospital San José, TecSalud, Nuevo Leon, Monterrey, Mexico
| | | | | | | | - Claudia Ortiz-Ledesma
- Escuela de Medicina y Ciencias de La Salud, Tecnologico de Monterrey, Monterrey, Nuevo Leon, Mexico
| | - Francisco Nevarez
- Escuela de Medicina y Ciencias de La Salud, Tecnologico de Monterrey, Monterrey, Nuevo Leon, Mexico
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Stokes N, Kikucki J. Management of Cardiac Arrest in the Pregnant Patient. CURRENT TREATMENT OPTIONS IN CARDIOVASCULAR MEDICINE 2018; 20:57. [DOI: 10.1007/s11936-018-0652-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Ho VT, Dua A, Lavingia K, Rothenberg K, Rao C, Desai SS. Thrombolysis for Venous Thromboembolism During Pregnancy: A Literature Review. Vasc Endovascular Surg 2018; 52:527-534. [PMID: 29804522 DOI: 10.1177/1538574418777822] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
BACKGROUND Pregnancy is a hypercoagulable state, conferring an increased risk of venous thromboembolism (VTE). However, treatment algorithms for deep venous thrombosis and pulmonary embolism are based on studies of nonpregnant patients. METHODS A literature review of cases in which thrombolysis was used for the treatment of VTE during pregnancy was conducted using the PubMed (National Institutes of Health) database. RESULTS A PubMed database search of English language articles for reports of thrombolysis for the treatment of VTE in pregnancy identified 215 cases, including 183 cases of systemic thrombolysis, 19 cases of catheter-directed thrombolysis, and 13 cases of mechanical thrombectomy. For systemic thrombolysis, the maternal complication rate was 4.40% and the fetal complication rate was 1.65%. For catheter-directed thrombolysis, the maternal complication rate was 14.75% and the fetal complication rate was 5.2%. In cases of mechanical thrombectomy, there were no reported maternal or fetal complications. CONCLUSIONS Although conservative strategies are preferred in pregnancy, thrombolysis is an adjunct for limb or life-threatening VTE. Review of past reports suggests low rates of maternal and fetal complications following systemic thrombolysis and mechanical thrombectomy but higher rates of complications after catheter-directed thrombolysis in the treatment of VTE during pregnancy.
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Affiliation(s)
- Vy T Ho
- 1 Division of Vascular Surgery, Department of Surgery, Stanford Health Care, Stanford, CA, USA
| | - Anahita Dua
- 1 Division of Vascular Surgery, Department of Surgery, Stanford Health Care, Stanford, CA, USA
| | - Kedar Lavingia
- 1 Division of Vascular Surgery, Department of Surgery, Stanford Health Care, Stanford, CA, USA
| | - Kara Rothenberg
- 1 Division of Vascular Surgery, Department of Surgery, Stanford Health Care, Stanford, CA, USA.,2 Department of Surgery, University of California San Francisco-East Bay, San Francisco, CA, USA
| | - Christina Rao
- 3 Northwest Community Hospital, Arlington Heights, IL, USA
| | - Sapan S Desai
- 3 Northwest Community Hospital, Arlington Heights, IL, USA
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Sousa Gomes M, Guimarães M, Montenegro N. Thrombolysis in pregnancy: a literature review. J Matern Fetal Neonatal Med 2018; 32:2418-2428. [DOI: 10.1080/14767058.2018.1434141] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Affiliation(s)
- Marina Sousa Gomes
- Department of Obstetrics and Gynecology, Alto Minho Local Healthcare Unit, Viana do Castelo, Portugal
| | - Mariana Guimarães
- Department of Obstetrics and Gynecology, São João Hospital Center, Porto, Portugal
| | - Nuno Montenegro
- Department of Obstetrics and Gynecology, São João Hospital Center, Porto, Portugal
- Medicine Faculty, University of Porto, Porto, Portugal
- Institute of Public Health of the University of Porto, Porto, Portugal
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7
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Heavner MS, Zhang M, Bast CE, Parker L, Eyler RF. Thrombolysis for Massive Pulmonary Embolism in Pregnancy. Pharmacotherapy 2017; 37:1449-1457. [DOI: 10.1002/phar.2025] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Affiliation(s)
- Mojdeh S. Heavner
- Department of Pharmacy Practice and Science; University of Maryland School of Pharmacy; Baltimore Maryland
| | - Min Zhang
- Department of Pharmacy Services; Yale-New Haven Hospital; New Haven Connecticut
| | - Chelsea E. Bast
- Department of Pharmacy; Baylor University Medical Center; Dallas Texas
| | - Lindsey Parker
- Department of Pharmacy; The Johns Hopkins University Hospital; Baltimore Maryland
| | - Rachel F. Eyler
- Department of Pharmacy Practice; University of Connecticut School of Pharmacy; Storrs Connecticut
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Dhutia H, Sprigings D, Shukla A, Lloyd S. Successful low-dose thrombolysis of submassive pulmonary embolus in a pregnant patient. JRSM Open 2014; 5:2054270414527932. [PMID: 25057394 PMCID: PMC4012658 DOI: 10.1177/2054270414527932] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Low-dose thrombolysis was effective and safe in a pregnant woman with acute pulmonary embolism causing severe right ventricular dysfunction. This is the first reported case of successful thrombolysis for pulmonary embolus in pregnancy in the absence of shock.
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Affiliation(s)
- Harshil Dhutia
- Department of Cardiology, Northampton General Hospital, Northampton NN1 5BD, UK
| | - David Sprigings
- Department of Cardiology, Northampton General Hospital, Northampton NN1 5BD, UK
| | - Ami Shukla
- Department of Obstetrics and Gynaecology, Northampton General Hospital, Northampton NN1 5BD, UK
| | - Sue Lloyd
- Department of Obstetrics and Gynaecology, Northampton General Hospital, Northampton NN1 5BD, UK
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Saeed G, Möller M, Neuzner J, Gradaus R, Stein W, Langebrake U, Dimpfl T, Matin M, Peivandi A. Emergent surgical pulmonary embolectomy in a pregnant woman: case report and literature review. Tex Heart Inst J 2014; 41:188-94. [PMID: 24808782 DOI: 10.14503/thij-12-2692] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Acute pulmonary embolism is a leading cause of death during pregnancy and delivery in the United States. We describe the case of a 25-year-old woman who presented in cardiogenic shock in week 38 of her first pregnancy. After the emergent cesarean delivery of a healthy male neonate, the mother underwent immediate surgical pulmonary embolectomy. We confirmed the diagnosis of pulmonary embolism intraoperatively by means of transesophageal echocardiography and removed large clots from the patient's pulmonary arteries. Mother and child were doing well, 27 months later. In addition to presenting our patient's case, we discuss the other relevant reports and the options for treating massive pulmonary embolism during pregnancy.
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Affiliation(s)
- Giovanni Saeed
- Departments of Cardiovascular Surgery (Drs. Matin, Peivandi, and Saeed), Internal Medicine II and Cardiology (Drs. Gradaus, Möller, and Neuzner), Gynecology and Obstetrics (Drs. Dimpfl and Stein), and Anesthesiology and Intensive Care Medicine (Dr. Langebrake), Klinikum Kassel GmbH, 34125 Kassel, Germany
| | - Michael Möller
- Departments of Cardiovascular Surgery (Drs. Matin, Peivandi, and Saeed), Internal Medicine II and Cardiology (Drs. Gradaus, Möller, and Neuzner), Gynecology and Obstetrics (Drs. Dimpfl and Stein), and Anesthesiology and Intensive Care Medicine (Dr. Langebrake), Klinikum Kassel GmbH, 34125 Kassel, Germany
| | - Jörg Neuzner
- Departments of Cardiovascular Surgery (Drs. Matin, Peivandi, and Saeed), Internal Medicine II and Cardiology (Drs. Gradaus, Möller, and Neuzner), Gynecology and Obstetrics (Drs. Dimpfl and Stein), and Anesthesiology and Intensive Care Medicine (Dr. Langebrake), Klinikum Kassel GmbH, 34125 Kassel, Germany
| | - Rainer Gradaus
- Departments of Cardiovascular Surgery (Drs. Matin, Peivandi, and Saeed), Internal Medicine II and Cardiology (Drs. Gradaus, Möller, and Neuzner), Gynecology and Obstetrics (Drs. Dimpfl and Stein), and Anesthesiology and Intensive Care Medicine (Dr. Langebrake), Klinikum Kassel GmbH, 34125 Kassel, Germany
| | - Werner Stein
- Departments of Cardiovascular Surgery (Drs. Matin, Peivandi, and Saeed), Internal Medicine II and Cardiology (Drs. Gradaus, Möller, and Neuzner), Gynecology and Obstetrics (Drs. Dimpfl and Stein), and Anesthesiology and Intensive Care Medicine (Dr. Langebrake), Klinikum Kassel GmbH, 34125 Kassel, Germany
| | - Uwe Langebrake
- Departments of Cardiovascular Surgery (Drs. Matin, Peivandi, and Saeed), Internal Medicine II and Cardiology (Drs. Gradaus, Möller, and Neuzner), Gynecology and Obstetrics (Drs. Dimpfl and Stein), and Anesthesiology and Intensive Care Medicine (Dr. Langebrake), Klinikum Kassel GmbH, 34125 Kassel, Germany
| | - Thomas Dimpfl
- Departments of Cardiovascular Surgery (Drs. Matin, Peivandi, and Saeed), Internal Medicine II and Cardiology (Drs. Gradaus, Möller, and Neuzner), Gynecology and Obstetrics (Drs. Dimpfl and Stein), and Anesthesiology and Intensive Care Medicine (Dr. Langebrake), Klinikum Kassel GmbH, 34125 Kassel, Germany
| | - Meradjoddin Matin
- Departments of Cardiovascular Surgery (Drs. Matin, Peivandi, and Saeed), Internal Medicine II and Cardiology (Drs. Gradaus, Möller, and Neuzner), Gynecology and Obstetrics (Drs. Dimpfl and Stein), and Anesthesiology and Intensive Care Medicine (Dr. Langebrake), Klinikum Kassel GmbH, 34125 Kassel, Germany
| | - Ali Peivandi
- Departments of Cardiovascular Surgery (Drs. Matin, Peivandi, and Saeed), Internal Medicine II and Cardiology (Drs. Gradaus, Möller, and Neuzner), Gynecology and Obstetrics (Drs. Dimpfl and Stein), and Anesthesiology and Intensive Care Medicine (Dr. Langebrake), Klinikum Kassel GmbH, 34125 Kassel, Germany
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10
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Successful thrombolysis of stroke with intravenous alteplase in the third trimester of pregnancy. J Neurol 2014; 261:632-4. [PMID: 24570282 DOI: 10.1007/s00415-014-7286-y] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2013] [Revised: 02/10/2014] [Accepted: 02/12/2014] [Indexed: 10/25/2022]
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Abstract
The relative hypercoagulable state of pregnancy leads to an increased risk of thrombotic complications, of which some may be life-threatening or medically devastating. In the non-pregnant patient, the current guidelines suggest thrombolysis as the primary treatment in acute ischemic stroke, myocardial infarction when percutaneous intervention is unavailable, certain cases of mechanical valve thrombosis, and pulmonary embolism with hemodynamic compromise or shock. Given that clinical trial data regarding thrombolytic use in pregnant women are absent due to exclusion, the goal of this review is to summarize the available published data regarding the use of thrombolytic agents and subsequent outcomes and complications in pregnant women. Overall, the use of thrombolytic agents in pregnancy is associated with a relatively low reported complication rate, especially given the severe medical conditions for which they are indicated. The data would suggest that thrombolysis should be considered for appropriate indications similar to that of non-pregnant patients. However, caution should be exercised when drawing conclusions regarding maternal and fetal safety, given the lack of controlled clinical trials including pregnant women and the nature of the weak evidence level of the cumulative data presented in this review.
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Affiliation(s)
- Eric J Gartman
- Pulmonary, Critical Care, and Sleep Medicine, Warren Alpert Medical School of Brown University, Memorial Hospital of Rhode Island, Pawtucket, RI, USA
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Conti E, Zezza L, Ralli E, Comito C, Sada L, Passerini J, Caserta D, Rubattu S, Autore C, Moscarini M, Volpe M. Pulmonary embolism in pregnancy. J Thromb Thrombolysis 2013; 37:251-70. [DOI: 10.1007/s11239-013-0941-9] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
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13
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Pulmonary hypertension in pregnancy: critical care management. Pulm Med 2012; 2012:709407. [PMID: 22848817 PMCID: PMC3399488 DOI: 10.1155/2012/709407] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2012] [Accepted: 04/25/2012] [Indexed: 11/17/2022] Open
Abstract
Pulmonary hypertension is common in critical care settings and in presence of right ventricular failure is challenging to manage. Pulmonary hypertension in pregnant patients carries a high mortality rates between 30-56%. In the past decade, new treatments for pulmonary hypertension have emerged. Their application in pregnant women with pulmonary hypertension may hold promise in reducing morbidity and mortality. Signs and symptoms of pulmonary hypertension are nonspecific in pregnant women. Imaging workup may have undesirable radiation exposure. Pulmonary artery catheter remains the gold standard for diagnosing pulmonary hypertension, although its use in the intensive care unit for other conditions has slowly fallen out of favor. Goal-directed bedside echocardiogram and lung ultrasonography provide attractive alternatives. Basic principles of managing pulmonary hypertension with right ventricular failure are maintaining right ventricular function and reducing pulmonary vascular resistance. Fluid resuscitation and various vasopressors are used with caution. Pulmonary-hypertension-targeted therapies have been utilized in pregnant women with understanding of their safety profile. Mainstay therapy for pulmonary embolism is anticoagulation, and the treatment for amniotic fluid embolism remains supportive care. Multidisciplinary team approach is crucial to achieving successful outcomes in these difficult cases.
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Ducarme G, Bonne S, Khater C, Ceccaldi PF, Poujade O, Luton D. [Acute non-obstetrical diseases during pregnancy and role of the obstetrician]. Presse Med 2011; 41:125-33. [PMID: 21632203 DOI: 10.1016/j.lpm.2011.04.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2011] [Revised: 03/17/2011] [Accepted: 04/07/2011] [Indexed: 10/14/2022] Open
Abstract
The management of a pregnant woman with an acute non-obstetrical disease must be made in narrow collaboration with an obstetrician. This one must be warned from the beginning of the care of the patient. In a pregnant woman, any acute medical, surgical or traumatic non-obstetrical disease can have obstetrical consequences. The diagnostic and therapeutic management of an acute non-obstetrical disease can have iatrogenic consequences during pregnancy. The most often described risks are early pregnancy loss, intra-uterine fetal death, placenta abruption, direct fetal hurts, preterm labor, prematurity and its complications. Obstetrical complications can induce maternal and neonatal life-threatening risks. Simple and easily accessible examinations in emergency allow detecting the obstetrical consequences of an acute non-obstetrical disease. During the management of an acute non-obstetrical disease in a pregnant woman, the induced obstetrical consequence of the disease can require emergency action of the obstetrician in conditions associated with maternal life-threatening risk. During the management of an acute non-obstetrical disease in a pregnant woman, once the mother condition was stabilized, the obstetrician had to estimate the fetal consequences and to adapt his or her therapeutic attitude. He or she sets up the fetal and placental surveillance adapted to the obstetrical risks and decides on the duration of this surveillance.
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Affiliation(s)
- Guillaume Ducarme
- Université Paris VII, Assistance publique-Hôpitaux de Paris (AP-HP), hôpital Beaujon, département de gynécologie obstétrique, 100, boulevard du Général-Leclerc, 92110 Clichy, France.
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