Abstract:

Pulmonary embolism (PE) is a clinical syndrome in which the pulmonary artery or its branches are obstructed by endogenous or exogenous emboli, resulting in circulatory abnormalities and cardiac dysfunction. A case of acute pulmonary embolism in the third trimester of pregnancy was successfully treated. The patient was admitted to our hospital because of "threatened preterm labor". Venous thromboembolism assessment on admission did not indicate high risk. However, the patient developed palpitation, chest tightness and dyspnea after forced defecation on the fourth day of admission. The patient had the increased heart rate, decreased blood oxygen, normal blood pressure, and increased D-dimer, and no other obvious abnormalities. Electrocardiogram showed the moderate ST depression and abnormal T wave. Ultrasound examination showed a very slow flow rate of deep veins of both lower limbs, mild pulmonary hypertension, and slightly enlarged right ventricle. Other ultrasound examination showed no obvious abnormalities. After multidisciplinary consultation and discussion, the acute pulmonary embolism during pregnancy was considered. This disease was characterized by acute onset and rapid progress. Therefore, the patient after the emergency cesarean section of the lower uterine segment was transferred to the ICU of the general hospital for treatment. After the transfer, the patient had respiratory failure and mechanical ventilation could not maintain oxygenation. The patient was treated with veno-venous extracorporeal membrane oxygenation (V-V ECMO) to maintain oxygenation, and then received symptomatic treatment such as thrombectomy and thrombolysis. After active treatment, the patient had a good prognosis. The purpose of this case report is to improve the awareness and alertness of pulmonary embolism during pregnancy, and to remind clinicians that the risk factors should be dynamically and individually assessed, to achieve early detection and timely prevention, so as to save the lives of mothers and infants and reduce the fatality.

Key words: Pulmonary embolism, Venous thromboembolism, Pregnancy trimester, third, Mechanical thrombolysis, Risk factors