Key result
In pregnant women with acute pulmonary embolism and haemodynamic instability, systemic thrombolysis or alternative reperfusion strategies such as surgical embolectomy or catheter-directed treatments must be considered despite pregnancy being a relative contraindication.
For pregnant women presenting with high-risk pulmonary embolism and haemodynamic instability, life-saving reperfusion therapies such as systemic thrombolysis or mechanical thrombectomy should be considered by a multidisciplinary team despite bleeding risks.
Supports multidisciplinary reperfusion consideration in unstable pregnant PE; leaves open controlled trials on maternal-fetal safety.
Diagnosis of acute PE in pregnant women with haemodynamic instability is following the general integrated risk-adapted diagnostic algorithm and starts with bedside echocardiography to assess RV function. If RV dysfunction is identified, a prompt and immediate reperfusion without further imaging should be initiated. Although pregnancy is listed as a relative contraindication of systemic thrombolysis, in pregnant women with acute PE and haemodynamic instability thrombolysis must be considered. In those cases, other treatment strategies as surgical embolectomy or catheter-directed low-dose thromboylysis or percutaneous thrombectomy should be taken into consideration as well. A multidisciplinary team with experience of PE management in pregnancy should be consulted to reach consensus on the best treatment approach.
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Hobohm et al. (2022) conducted a review in Pulmonary Embolism in Pregnancy. Diagnostic and therapeutic reperfusion strategies (including systemic thrombolysis and catheter-directed treatments) was evaluated. In pregnant women with acute pulmonary embolism and haemodynamic instability, systemic thrombolysis or alternative reperfusion strategies such as surgical embolectomy or catheter-directed treatments must be considered despite pregnancy being a relative contraindication.
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