Does streptokinase safely and effectively treat acute massive pulmonary embolism during labour and delivery?
Streptokinase may be administered for acute massive pulmonary embolism during labour, but carries a risk of severe postpartum haemorrhage that may require specific management strategies.
A 29-year-old woman sustained an acute massive pulmonary embolism in the 32nd week of pregnancy. Rapid clinical improvement followed the use of streptokinase. Treatment was continued for 41 hours, including labour and the first three hours after delivery. There was slow but severe postpartum haemorrhage. Partial uterine atony occurred, and may have been due, at least in part, to fibrin degradation products arising from thrombolysis. No adverse effects were noted in the baby.Our experience suggests that streptokinase may be given during labour but that an oxytocic agent may be needed; and that reversal of fibrinolysis before delivery is best achieved by the use of aprotinin (Trasylol) rather than aminocaproic acid.
Hall et al. (Sat,) studied this question.