Massive pulmonary embolism during pregnancy successfully treated with recombinant tissue plasminogen activator - A case report and review of treatment options

Thromboembolic disease is an important cause of morbidity and mortality during pregnancy. Berg and colleagues found that 11% of maternal deaths during pregnancy were related to pulmonary embolism (PE). Another study revealed that up to 40% of pregnant women with asymptomatic deep vein thrombosis (DVT) may also have concurrent PE. Women are at increased risk for DVT and PE during pregnancy for several reasons. Pregnancy is a thrombophilic state; fibrinogen levels are increased, and during the final trimester there is a decrease in fibrinolytic activity. In addition, the gravid uterus causes compression and stasis in the lower extremities and pelvic veins favoring thrombosis. Finally, women with a history of thrombotic complications during pregnancy have an increased prevalence of genetic mutations related to coagulation.