Pulmonary embolism in pregnancy

What is pulmonary embolism?

Pulmonary embolism is a serious condition associated with closure or narrowing of the lumen of the pulmonary vessels by embolic material. Most often it is a thrombus originating in the veins of the lower extremities. Pulmonary embolism can also occur as a result of air embolism, fat embolism or embolism caused by amniotic fluid. However, these are much rarer situations. The most common pulmonary embolism is associated with venous thrombosis.

Read also:
Venous thromboembolism in pregnancy – symptoms, prevention

What are the symptoms of pulmonary embolism in pregnancy?

Pregnant women are at risk for pulmonary embolism because of the increased thromboembolic risk that occurs during pregnancy and the postpartum period. Symptoms of pulmonary embolism often appear suddenly and require contacting a doctor as soon as possible to implement appropriate treatment.  

Symptoms of pulmonary embolism in pregnancy include:

• dyspnea,
• cough,
• hemoptysis,
• chest pain,
• blackout

It is recognized that in about one-third of cases it is possible to identify symptoms of deep vein thrombosis, such as pain in the calf especially when walking or swelling of the limb, before the onset of pulmonary embolism.

In laboratory tests, the concentration of D – dimers will be elevated in case of embolism. However, it is worth mentioning that the concentration of this protein is “naturally” elevated during pregnancy, so the result should be related to the symptoms that occur in the mother-to-be.

Treatment of pulmonary embolism in pregnancy

The treatment of choice for pulmonary embolism in pregnancy is the use of low-molecular-weight heparin (e.g., Clexane/ Neoparin). The dose of heparin should be therapeutic, not prophylactic. The doctor adjusts it to the weight of the pregnant woman. During pregnancy, fibrinolytic treatment is the last resort, as it can have serious complications for the baby. However, treatment decisions are made on a case-by-case basis depending on the woman’s symptoms, condition and test results.

Prevention of pulmonary embolism in pregnancy

A history of venous thrombosis or pulmonary embolism is a serious risk factor for reoccurrence of venous thromboembolism in pregnancy. For this reason, in women at high risk of these vascular complications, low-molecular-weight heparin injections are recommended during pregnancy. Prophylaxis should also be continued for 6 weeks in the postpartum period, as the risk of thrombosis during this period is even higher than during pregnancy.