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首页> 外文期刊>Case Reports in Obstetrics and Gynecology >Systemic Thrombolysis for Treatment of Postpartum Saddle Embolism Complicated by Postpartum Hemorrhage: A Case Report and Brief Literature Review
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Systemic Thrombolysis for Treatment of Postpartum Saddle Embolism Complicated by Postpartum Hemorrhage: A Case Report and Brief Literature Review

机译：产后出血治疗产后马鞍栓塞的全身溶栓 - 案例报告及简短文学综述

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Venous thromboembolic events (VTE), specifically pulmonary embolisms, account for a significant portion of maternal morbidity and mortality. Due to the procoagulant physiological changes that occur, pregnancy and the postpartum period are known risk factors for thromboembolic events. The risk is greatest during the first-week postpartum and remains elevated for up to six weeks as compared to the general population. Treatment guidelines regarding the use of thrombolytics for massive pulmonary embolism occurring in pregnancy and the postpartum are not well established. In nonpregnant populations, thrombolytic agents are well known to decrease the mortality in the setting of a massive pulmonary embolism. However, in the absence of management guidelines, thrombolysis in pregnancy remains guided by case reports and case series. We present a case of a massive pulmonary embolism (PE) causing hemodynamic instability during the postpartum period treated with tissue plasminogen activator (tPA). The case was complicated by delayed postpartum hemorrhage successfully managed with the uterotonic methylergometrine. The patient was started on oral anticoagulation and continued for six months without recurrent VTE. Our case demonstrates a rare occurrence of a saddle embolism after a vaginal delivery within the first postpartum week which was successfully managed with the use of systemic thrombolysis and minimal intervention to manage the iatrogenic delayed postpartum hemorrhage. To the authors’ knowledge, no other similar case report exists. This case highlights the need to develop guidelines for the use of thrombolysis in mothers who present with massive pulmonary embolus and a noninvasive means to manage adverse bleeding events in the puerperium.
机译：静脉血栓栓塞事件（VTE），具体肺栓塞，占产妇的发病率和死亡率的显著部分。由于发生的促凝生理变化，怀孕和产后期被称为血栓栓塞事件的危险因素。第一周产后持续升高六个星期相比，一般人群中的风险是最大的。关于使用溶栓对大面积肺栓塞在怀孕和产后出现的治疗指南没有很好地建立。在非妊娠人群，溶栓药物是众所周知的，以降低死亡率在大块肺栓塞的设置。然而，在缺乏管理的指导方针，溶栓怀孕仍受到病例报告和病例系列指导。我们提出了一个大块肺栓塞（PE）中组织型纤溶酶原激活剂（tPA）处理产后期间引起血流动力学不稳定的情况。该案件是延迟的产后出血与子宫收缩缩水苹果酸甲基麦角新碱成功地管理复杂。该患者开始口服抗凝并持续半年未复发性静脉血栓栓塞。我们的案例证明了产后第一周内阴道分娩，其成功与使用全身溶栓和最小干预的管理医源性迟发性产后出血管理后，骑跨栓塞的一种罕见的发生。据笔者所知，没有其他类似的病例报告存在。这种情况下，强调有必要制定与大规模肺栓塞和管理在产褥期出血不良事件的一种非侵入性手段展示谁的母亲溶栓治疗的指导方针。

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