Massive pulmonary embolism in pregnancy treated with tissue plasminogen activator.
BACKGROUND
Systemic thrombolysis with tissue plasminogen activator (t-PA) in pregnancy is still considered an experimental treatment. Several reports have described the successful use of t-PA in the setting of hemodynamic instability in gravidas with massive pulmonary emboli.


METHODS
A 34-year-old woman received a diagnosis of severe pulmonary embolism at 23 weeks of gestation. She developed pulmonary hypertension and became hemodynamically unstable. Thrombolytic therapy using t-PA was administered. The patient tolerated thrombolysis well and delivered at term. No placental abnormalities were identified on ultrasonogram or after delivery. The patient was also found to be a heterozygous carrier of prothrombin G20210A mutation.


CONCLUSIONS
We describe the successful thrombolysis with t-PA of a massive, life-threatening pulmonary embolism without complications followed by a term delivery.
Trukhacheva
Elena
E
Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, Texas 77054, USA. elenat@bcm.tmc.edu
Scharff
Michael
M
Gardner
Michael
M
Lakkis
Nasser
N
D000328:Adult; D005260:Female; D005343:Fibrinolytic Agents / Q000627:therapeutic use*; D006579:Heterozygote; D006801:Humans; D009154:Mutation; D011247:Pregnancy; D011249:Pregnancy Complications, Cardiovascular / Q000175:diagnosis / Q000188:drug therapy* / Q000235:genetics; D011256:Pregnancy Outcome; D011262:Pregnancy Trimester, Second; D011516:Prothrombin / Q000235:genetics; D011655:Pulmonary Embolism / Q000175:diagnosis / Q000188:drug therapy* / Q000235:genetics; D010959:Tissue Plasminogen Activator / Q000627:therapeutic use*
D005343:Fibrinolytic Agents; D011516:Prothrombin; D010959:Tissue Plasminogen Activator