TITLE:
Peripartum pulmonary embolism: Anesthetic and surgical considerations
AUTHORS:
Nissar Shaikh, Firdous Ummunnisa, Naseera Aboobacker, Mustafa Gazali, Ousama Kokash
KEYWORDS:
Peripartum Pulmonary Embolism; Computerized Tomographic Pulmonary Angiography; Low Molecular Weight Heparin
JOURNAL NAME:
Open Journal of Obstetrics and Gynecology,
Vol.3 No.1A,
February
5,
2013
ABSTRACT:
Pregnancy and peripartum period leads to Virchow’s triad (hypercoagulability, venous stasis and vascular injury) thereby increasing the risk of thromboembolism by many folds in these patients. Accurate diagnosis of peripartum pulmonary embolism is pertinent for reducing morbidity and mortality. Accurate diagnosis is also vital for avoiding the adverse effects of unwanted anticoagulation in pregnant mother and fetus in a patient wrongly diagnosed with this condition. Computerized tomographic pulmonary angiography has a high specificity and sensitivity in comparison to ventilation/perfusion scan for diagnosis of peripartum pulmonary embolism (PPE). It has a lower fetal radiation exposure and aids in arriving at an alternative diagnosis, if PPE is absent. Low molecular weight heparin is the medication of choice in the treatment of peripartum pulmonary embolism. Thrombolysis is considered in patients with massive PPE and hemodynamic instability, refractory hypoxia or right ventricular dysfunction. Regional anesthesia/analgesia can be given safely in these patients. We report two cases of PPE and review the anesthetic and surgical consideration.