Published online May 6, 2022. doi: 10.12998/wjcc.v10.i13.4226
Peer-review started: September 23, 2021
First decision: January 10, 2022
Revised: January 21, 2022
Accepted: March 16, 2022
Article in press: March 16, 2022
Published online: May 6, 2022
Processing time: 218 Days and 18.9 Hours
Thrombotic pulmonary embolism (TPE) is one of the most critical diseases in obstetrics but is rarely reported in caesarean section (CS) because TPE patients in CS have a high risk of death and are difficult to diagnose. This case report of TPE during CS was recorded by transthoracic echocardiography (TTE) and can provide a reference for the differential diagnosis of critical illnesses in CS.
A 37-year-old pregnant woman with rheumatic heart disease (RHD), gravida 5 and para 1 (G5P1), presented for emergency CS at 33 wk and 3 d of gestation under general anesthesia because of acute heart failure, pulmonary hypertension and arrhythmia. After placental removal during CS, TTE revealed a nascent thrombus in the inferior vena cava (IVC) that elongated, detached and fragmented leading to acute thromboembolic events and acute TPE. This report presents the whole process and details of TPE during CS and successful rescue without any sequelae in the patient. This case gives us new ideas for the diagnosis of death or cardiovascular accidents during CS in pregnant women with heart disease and the detailed presentation of the rapid development of TPE may also elucidate new ideas for treatment. This case also highlighted the importance of prophylactic anticoagulation in the management of heart disease during pregnancy.
Pregnancy with heart failure could trigger inferior vena cava (IVC)-origin TPE during CS. Detection and timely treatment can avoid serious consequences.
Core Tip: Thrombotic pulmonary embolism (TPE) is one of the most critical diseases in obstetrics but is rarely reported in caesarean section (CS), especially thrombus originating from the inferior vena cava. This case report describes a 37-year-old pregnant woman with rheumatic heart disease who developed TPE during CS and recorded the whole process by transthoracic echocardiography. This case provided experience for the differential diagnosis of amniotic fluid embolism in CS. This case also reminds us of the importance of pregnancy management and prophylactic anticoagulants in pregnant women with heart disease, and if not, an intensive care team is needed to ensure patient safety.