title: Intraoperative thrombolysis in a patient with cardiopulmonary arrest undergoing caesarean delivery.
abstract: Thromboembolic events during pregnancy remain a major cause of morbidity and mortality with possible catastrophic sequelae for the patient. The decision whether to use high-risk therapeutic thrombolytics during pregnancy or perinatally is complicated and many considerations pertain. We report on the thrombolytic management of a 34-year-old woman who had an asystolic cardiac arrest secondary to massive pulmonary embolism while undergoing emergency caesarean delivery. The patient was thrombolysed during successful cardiopulmonary resuscitation. Return of spontaneous circulation was accompanied by massive uterine bleeding. Instead of performing a postpartum hysterectomy, the uterus was preserved through continuous manual pressure and packing for four hours by the obstetric team until haemostasis was achieved. The patient survived and was later discharged without any major neurological deficit.
authors.affiliation: Department of Anesthesiology and Intensive Care, St. Franziskus Hospital Muenster, Muenster, Germany.
authors.forename: M
authors.initials: M
authors.lastname: Wenk
authors.forename: D M
authors.initials: DM
authors.lastname: Pöpping
authors.forename: S
authors.initials: S
authors.lastname: Hillyard
authors.forename: H
authors.initials: H
authors.lastname: Albers
authors.forename: M
authors.initials: M
authors.lastname: Möllmann
mesh_terms: D000328:Adult; D016887:Cardiopulmonary Resuscitation / Q000379:methods; D002585:Cesarean Section; D003422:Critical Care; D005260:Female; D005343:Fibrinolytic Agents / Q000627:therapeutic use; D006323:Heart Arrest / Q000188:drug therapy*; D006439:Hemodynamics / Q000502:physiology; D006801:Humans; D007036:Hypothermia, Induced; D007431:Intraoperative Complications / Q000188:drug therapy*; D011247:Pregnancy; D011250:Pregnancy Complications, Hematologic / Q000188:drug therapy*; D011655:Pulmonary Embolism / Q000188:drug therapy; D011994:Recombinant Proteins / Q000627:therapeutic use; D015912:Thrombolytic Therapy; D010959:Tissue Plasminogen Activator / Q000627:therapeutic use; D014592:Uterine Hemorrhage / Q000139:chemically induced
chemical_list: D005343:Fibrinolytic Agents; D011994:Recombinant Proteins; C087896:reteplase; D010959:Tissue Plasminogen Activator