Pulmonary embolism in pregnancy- Management

Pulmonary embolism in pregnancy- Management

It is a blockage, usually a blood clot, that prevents oxygen from reaching the tissues of the lungs; it can be life-threatening.

Diagnostic criteria

• Acute onset of shortness of breath (dyspnea)

• Pleuritic chest pain

• Cough and/or hemoptysis

• Low grade fever

• Tachypnea

• Diminished oxygen saturation

• Diminished breath sounds

Investigations

• Venous Doppler ultrasound

• Pulmonary angiography

• CT scan, MRI

• D-dimer

Non-pharmacological treatment

• Respiratory support and oxygen supplementation

Pharmacological treatment

• Unfractionated heparin (UFH) is the treatment of choice: loading dose 150 U/kg (or minimum of 5000 U) followed by initial infusion 15–25 U/kg/hour (or minimum of 1000 U/hourly)

Note: Check PTT every 4 hours and adjust infusion to maintain PTT at 1.5–2.5 × control. Once steady state has been achieved, measure PTT levels daily. Change heparin to SC route after 5–10 days to avoid formation of hematoma.

Referral

Immediate referral to a health facility where expertise and monitoring of the treatment through laboratory tests is available is recommended.