Massive Pulmonary Embolism in a Pregnant Woman with an Excellent Response to Early Thrombolytic Therapy

Thrombolytic agents have been used successfully to treat patients with massive pulmonary embolism and cardiorespiratory insufficiency. Experience with these drugs in pregnancy is limited, nevertheless. We report a 32-year-old pregnant female, who was at 16 weeks of gestation, presented with acute collapse and progressive dyspnea caused by massive pulmonary embolism. The diagnosis was rapidly made in the emergency department with two dimensional-doppler echocardiography that showed signs of right ventricular dysfunction and pulmonary hypertension, as well as direct visualisation of large thrombus at the bifurcation of the main pulmonary artery. Because of significant haemodynamic instability and no improvement after intravenous heparin, the patient was successfully treated with recombinant tissue plasminogen activator and low-molecular-weight heparin. The response to fibrinolytic therapy was excellent without haemorrhagic complications and a healthy child was born at term. We conclude that early thrombolytic therapy may be a reasonable treatment for pregnant patients with unstable pulmonary embolism. (Hong Kong j.emerg.med. 2014;21:260-265)