Successful thrombolysis for pulmonary embolism during pregnancy

Pulmonary embolism is a serious and potentially life-threatening condition, particularly during pregnancy, and is one of the leading causes of maternal mortality. A 40-year-old female patient at 27–28 weeks of pregnancy was admitted to the hospital with complaints of shortness of breath at rest, dizziness, and loss of consciousness. Three days before admission, she suddenly felt nagging pain in the groin area, which was aggravated by walking. Contrast-enhanced computed tomography (CT) of the chest revealed CT signs of massive thromboembolism of the pulmonary artery. The Qanadli index was 67.5%. Duplex scanning of the veins of the lower extremities revealed thrombosis of the left common femoral vein with a flotation of 6 cm. Following a multidisciplinary consultation, systemic thrombolysis with Alteplase at a dose of 100 mg once was initiated according to vital indications. Improvement was immediately noted in the first hours after thrombolytic therapy. The efficiency of the therapy and satisfactory condition of the mother and fetus extended the pregnancy to 38 weeks. At full term, the patient underwent a successful cesarean section. The postpartum period proceeded without thromboembolic complications during anticoagulant therapy. This clinical case demonstrates that timely systemic thrombolysis can prolong pregnancy to full term and preserve the life and health of the mother and fetus.