Why the study?
Pulmonary embolism is a lethal complication during pregnancy and the puerperium with elevated risk after cesarean section, but its diagnosis can be challenging.
A dilated left ventricle on echocardiography does not exclude acute pulmonary embolism in the postpartum setting, and catheter-directed angiography may be necessary for definitive diagnosis and treatment in life-threatening emergencies.
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Rapid postpartum PE deterioration after cesarean warrants heightened vigilance; leaves open optimal peripartum diagnostic protocols.
Introduction Pulmonary embolism is a lethal complication during pregnancy and the puerperium. Compared with vaginal delivery, the risk of pulmonary disease is almost twice as high with cesarean section. However, diagnosing a pulmonary embolism can be challenging. Case presentation A 31-year-old nulliparous woman underwent cesarean section. Postoperatively, the patient suddenly developed dyspnea and dull pain in the left back region and cardiopulmonary function deteriorated rapidly. Venous ultrasonography confirmed thrombosis of the left common iliac vein. Transthoracic echocardiography revealed a normal right heart and a dilated left ventricle with a patent foramen ovale. An acute pulmonary embolism was confirmed by pulmonary angiography. Catheter-directed thrombus fragmentation and thrombolysis were then performed. Conclusion Dilated left ventricular echocardiography does not exclude postpartum acute pulmonary embolism. In extreme emergencies, when acute pulmonary embolism is the most likely diagnosis and life-threatening, catheter-directed angiography may be preferred over other approaches.
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Song et al. (2023) studied this question.
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