Case Report
Copyright ©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Apr 6, 2020; 8(7): 1311-1318
Published online Apr 6, 2020. doi: 10.12998/wjcc.v8.i7.1311
Severe venous thromboembolism in the puerperal period caused by thrombosis: A case report
Ji Zhang, Jing-Li Sun
Ji Zhang, Jing-Li Sun, Department of Obstetrics and Gynecology, General Hospital of Northern Theater Command (Heping Campus), Shenyang 110000, Liaoning Province, China
Author contributions: Zhang J was the patient’s attending gynecology and obstetrics physician, reviewed the literature and contributed to manuscript drafting; Sun JL analyzed and interpreted the imaging findings and was responsible for revision of the manuscript for important intellectual content; all authors issued final approval for the version to be submitted.
Informed consent statement: Informed written consent was obtained from the patient for publication of this report and any accompanying images.
Conflict-of-interest statement: The authors declare that they have no conflict of interest.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Jing-Li Sun, MAMS, Chief Physician, Department of Obstetrics and Gynecology, General Hospital of Northern Theater Command (Heping Campus), No. 5 Guangrong Street, Heping District, Shenyang 110000, Liaoning Province, China. zg3416@sina.com
Received: December 1, 2019
Peer-review started: December 1, 2019
First decision: December 23, 2019
Revised: January 13, 2020
Accepted: March 9, 2020
Article in press: March 9, 2020
Published online: April 6, 2020
Processing time: 126 Days and 15.6 Hours
Abstract
BACKGROUND

The incidence of venous thromboembolism (VTE) in pregnant women is significantly higher than that in non-pregnant women. VTE is more common after delivery than before delivery, and this condition can be hidden and develops rapidly. VTE mainly includes deep vein thrombosis and pulmonary embolism. Thrombophilia is an important risk factor for VTE in pregnant women and includes acquired thrombophilia and hereditary thrombophilia.

CASE SUMMARY

A 24-year-old nulliparous female patient underwent cesarean section of the lower uterus due to fetal distress. Anti-inflammatory rehydration was given after the operation to prevent thrombosis. The patient had no obvious discomfort after surgery. Ten days after the operation, the patient developed a fever. The patient's mother revealed that she had a previous history of a lower extremity venous thrombosis. Color Doppler ultrasound showed deep vein thrombosis in the left lower extremity. The results of computed tomography angiography showed that the patient had a double pulmonary artery embolism. Bilateral lower extremity antegrade venography, inferior vena cava angiography and filter placement were performed. The patient continued to receive anticoagulant therapy. After 2 wk, the patient's condition improved. An anticoagulant protein test was performed 2 mo after discharge, and the results showed that both the patient and her mother had reduced protein S.

CONCLUSION

Clinicians should learn to recognize the high-risk factors for VTE, improve their understanding of VTE, and actively prevent and diagnose VTE as early as possible.

Keywords: Venous thromboembolism; Pregnant women; Thrombophilia; Early diagnosis; Therapy; Case report

Core tip: Thrombophilia is an important risk factor for venous thromboembolism (VTE) in pregnant women. We present herein, a rare case of severe VTE caused by thrombophilia in the puerperium period. The severe VTE in this patient with a family history of lower extremity venous thrombosis developed rapidly into pulmonary embolism, but the clinical symptoms were not typical, and the diagnosis was confirmed by ultrasonography and pulmonary computed tomography angiography. This case demonstrates that clinicians should learn to recognize the high risk factors for VTE, and improve their understanding of thrombophilia during pregnancy and puerperium.