gms | German Medical Science

Introduction: Pulmonary embolism (PE) is one of the leading causes of maternal mortality. Because of the Virchow’s triad (hypercoagulability, vascular damage and venous stasis) the venous thromboembolism risk during pregnancy is much higher.

Material and methods: We present two different procedures, both PE during pregnancy. The first case was a 33-year-old pregnant woman, at the 24 week of pregnancy with a recurring PE and a deep vein thrombosis. She was admitted to our hospital with symptoms of cardiogenic shock. An urgent pulmonary embolectomy was performed. One day postoperative pregnancy had to be interrupted because of fetal death. The postoperative course was without any adverse events. The second case was an 18-year-old pregnant woman with a heterozygous factor V Leiden, at 36 weeks of pregnancy, with acute massive pulmonary embolism without any signs of venous thrombosis. At arriving at the cardiac ICU she was orientated and hemodynamic stable. The echocardiogram showed a distended right ventricle with no sign of hypokinesia. Pelvenic examination and ultrasound showed regular fetal heart beat, regular placental and liquid presence. After a multidisciplinary approach she was treated with unfractionated heparin intravenously. A caesarean section was performed at week 38 of pregnancy. The course for mother or child in the following days or after discharge were uneventful.

Conclusion: A multidisciplinary approach is necessary, when a life-threatening massive pulmonary embolism is developing during the pregnancy. Thromboprophylaxis appropriate to the level of risk remains the key to reducing morbidity and mortality, e.g. unfractionated heparin therapy can be initiated. Daily echocardiographic exams and laboratory tests can be useful tools to make a shorting of watchful waiting as long the mother stays hemodynamic stable. In conclusion the second opinion of watchful waiting is the superior.