Thrombolysis for massive pulmonary embolism in pregnancy: a case report

Mortality from pulmonary embolism (PE) in pregnancy might be related to challenges in targeting the right population for prevention, ensuring that diagnosis is suspected and adequately investigated, and initiating timely and best possible treatment of this disease. We present here the case of a pregnant woman patient with massive PE successfully thrombolysed. A 42-year-old pregnant (at 14 weeks) woman was admitted 2 hours after onset of sudden acute dyspnea and chest pain. Immediate electrocardiogram showed typical S1-Q3-T3 pattern and incomplete right bundle branch block. The echocardiogram showed a distended right ventricle with free-wall hypokinesia and displacement of the interventricular septum toward the left ventricle. Thrombolysis with recombinant tissue plasminogen activator and heparin (alteplase 10 mg bolus, then 90 mg over 2 hours) was administered. Pelvic examination and ultrasound showed regular fetal heart beat, regular placental, and liquid presence. No problem in the subsequent days was evidenced for mother and fetus and at discharge. In conclusion, in pregnant patient with life-threatening massive PE, thrombolytic therapy could be administered, and the use of echocardiographic, laboratory, and clinical data could be useful tools to achieve a rapid diagnosis and a therapeutic decision, but additional studies need to be performed to further define its use.