[Parturient at full term with inferior vena cava thrombosis: anesthesia during surgical delivery].
Emergency cesarean section is a high-risk situation because of potential maternal-fetal complications. We report a case in which risk increased due to a massive thrombus in the mother's left common femoral vein extending to the vena cava. A 31-year-old woman with no relevant medical history in the 41st week of pregnancy was scheduled for induction. Two days before the planned induction she was admitted to the emergency department, where she was diagnosed with deep vein thrombosis in the left lower limb. She was transferred to the postanesthetic recovery unit, where a multidisciplinary team (from gynecology, hematology, interventional radiology, and anesthesiology) discussed various therapeutic options (thrombectomy, vena cava filter, or anticoagulation by intravenous infusion of unfractionated heparin). Given that deep vein thrombosis coincided with obstetric delivery, it was crucial to decide on anesthetic and therapeutic approaches that would assure maternal and fetal safety and prevent such complications as massive pulmonary thromboembolism.
Departamento de Anestesiologia, Hospital General Universitario Gregorio Marañón, Madrid. fdez_medina@hotmail.com
E
E
Fernández
N
N
Dueñas
A
A
Villafranca
M
M
Perea
B
B
Amorós
L
L
Bermejo
D000328:Adult; D000768:Anesthesia, General / Q000379:methods*; D000773:Anesthesia, Obstetrical / Q000379:methods*; D000925:Anticoagulants / Q000627:therapeutic use; D002585:Cesarean Section; D004630:Emergencies; D017984:Enoxaparin / Q000627:therapeutic use; D005260:Female; D005268:Femoral Vein; D006493:Heparin / Q000627:therapeutic use; D006801:Humans; D006473:Postpartum Hemorrhage / Q000517:prevention & control; D011247:Pregnancy; D011249:Pregnancy Complications, Cardiovascular / Q000188:drug therapy*; D011263:Pregnancy Trimester, Third; D011644:Puerperal Disorders / Q000517:prevention & control; D011655:Pulmonary Embolism / Q000517:prevention & control; D053828:Stockings, Compression; D013924:Thrombophlebitis / Q000188:drug therapy*; D014668:Vasotocin / Q000031:analogs & derivatives / Q000627:therapeutic use; D014682:Vena Cava, Inferior; D020246:Venous Thrombosis / Q000188:drug therapy*
D000925:Anticoagulants; D017984:Enoxaparin; C047046:atosiban; D006493:Heparin; D014668:Vasotocin