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Catheter-Directed Thrombolytic Therapy in the Management of Massive Pulmonary Embolism in Pregnancy

Gowda, Niraj MD; Nwabuobi, Chinedu K. MD, MS; Louis, Judette M. MD, MPH

doi: 10.1097/AOG.0000000000003532
Contents: Medical Complications of Pregnancy: Case Report
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BACKGROUND: Pulmonary embolism is one of the most common causes of maternal mortality and can be classified into low-risk, submassive, and massive. Three treatment options exist for massive pulmonary embolism in nonpregnant patients: thrombolysis, percutaneous catheter-based embolectomy, or surgical embolectomy; however, there is limited evidence to guide management of pulmonary embolism in pregnancy.

CASE: We present a case of massive pulmonary embolism in pregnancy. Our patient presented with pulmonary embolism with biomarker and imaging evidence of right heart strain. She developed hypotension and an increased oxygen requirement and was subsequently treated with ultrasound-assisted catheter-directed thrombolysis. She was discharged on low-molecular-weight heparin and had a normal spontaneous vaginal delivery at 39 weeks of gestation.

CONCLUSIONS: Catheter-directed thrombolysis is preferred to systemic thrombolytic therapy in pregnant patients with massive pulmonary embolism requiring thrombus removal.

Catheter-directed thrombolysis is preferred to systemic thrombolytic therapy in pregnant patients with massive pulmonary embolism requiring thrombus removal.

Department of Internal Medicine, George Washington University School of Medicine and Health Sciences, Washington, DC; and the Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, University of South Florida, Morsani College of Medicine, Tampa, Florida.

Corresponding author: Niraj Gowda, MD, Department of Internal Medicine, George Washington University School of Medicine and Health Sciences Medicine, Washington, DC; email: ngowda2015@gmail.com.

Financial Disclosure The authors did not report any potential conflicts of interest.

Each author has confirmed compliance with the journal's requirements for authorship.

Peer reviews and author correspondence are available at http://links.lww.com/AOG/B559.

© 2019 by the American College of Obstetricians and Gynecologists. Published by Wolters Kluwer Health, Inc. All rights reserved.