title: Massive hemorrhage following thrombolysis for postpartum pulmonary embolism with cardiac arrest.
abstract: BACKGROUND
  Cardiac arrest following a massive pulmonary embolism in pregnancy or the puerperium is a rare and catastrophic event.
  
  
  METHODS
  We describe a case of massive pulmonary embolism with cardiac arrest in a 36-year-old patient, presenting 48 hours postpartum. She was treated with thrombolytic therapy and suffered a massive hemorrhage thereafter, which was compounded by disseminated intravascular coagulation. Following an emergency hysterectomy and massive blood-product transfusion, she survived with no neurological sequelae. The medical team present had participated in two simulation sessions with similar scenarios in the weeks before the event.
  
  
  CONCLUSIONS
  To our knowledge, this is only the fifth case reported in the literature on thrombolytic therapy in the postpartum period, and of these has the most severe hemorrhagic complication. An effective multidisciplinary approach to such a complex situation can be acquired through simulation-based training.
authors.affiliation: Department of Obstetrics and Gynaecology, Centre hospitalier universitaire Sainte-Justine, Montreal QC.
authors.forename: Talya
authors.initials: T
authors.lastname: Shaulov
authors.affiliation: Division of Hematology, Department of Pediatrics, Centre hospitalier universitaire Sainte-Justine, Montreal QC.
authors.forename: Michèle
authors.initials: M
authors.lastname: David
authors.affiliation: Department of Obstetrics and Gynaecology, Centre hospitalier universitaire Sainte-Justine, Montreal QC.
authors.forename: Marieve
authors.initials: M
authors.lastname: Pellerin
authors.affiliation: Division of Obstetrics Medicine, Department of Obstetrics and Gynaecology, Centre hospitalier universitaire Sainte-Justine, Montreal QC.
authors.forename: Francine
authors.initials: F
authors.lastname: Morin
mesh_terms: D000328:Adult; D005260:Female; D006323:Heart Arrest / Q000150:complications*; D006470:Hemorrhage / Q000139:chemically induced*; D006801:Humans; D011644:Puerperal Disorders / Q000188:drug therapy*; D011655:Pulmonary Embolism / Q000150:complications* / Q000188:drug therapy*; D012720:Severity of Illness Index; D015912:Thrombolytic Therapy / Q000009:adverse effects*
keywords: hemorrhage; pulmonary embolism; thrombolytic therapy