Successful experience with systemic thrombolysis during pregnancy
Background: Pulmonary embolism (PE) is the most serious venous thromboembolic event (VTE) and the leading cause of death in pregnant women and puerperas. The change in the hemostasiogram parameters (except for D-dimers) in VTE practically does not differ from that in physiological pregnancy. The first-line therapy for PE is drug treatment with thrombolytics and anticoagulants, the use of which in pregnant women is associated with a high risk for obstetric bleeding and adverse perinatal outcomes.Strizhakov A.N., Ignatko I.V., Bogomazova I.M., Belousova V.S., Timokhina E.V., Afanasyeva N.V., Khramova L.S.
Case report: The paper presents the results of examination and treatment in a 34-year-old female patient with PE that occurred at 24 weeks’ gestation and was diagnosed using chest computed tomography and pulmonary angiography. A systemic thrombolytic session was performed, followed by the placement of an inferior vena cava filter and by the administration of low-molecular-weight heparins at therapeutic doses, which allowed the patient to prolong pregnancy to full term and to give birth to a healthy baby.
Conclusion: The appearance of clinical symptoms (in this case, exertional dyspnea) is of paramount importance in predicting life-threatening pathological conditions and requires a detailed follow-up within the framework of timely diagnosis and specialized medical care.
Keywords
venous thromboembolic events
pulmonary embolism
systemic thrombolysis
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Received 06.04.2021
Accepted 20.05.2021
About the Authors
Alexander N. Strizhakov, Dr. Med. Sci., Academician of the Russian Academy of Sciences, Professor, Head of the Department of Obstetrics, Gynecology and Perinatology of the N.V. Sklifosovsky Institute of Clinical Medicine, I.M. Sechenov First Moscow State Medical University, Ministry of Health of the Russian Federation (Sechenov University), +7(499)782-30-45, kafedra-agp@mail.ru, 8-2 Trubetskaya str., Moscow, 119991, Russia.Irina V. Ignatko, Dr. Med. Sci., Corresponding Member of the Russian Academy of Sciences, Professor of the Russian Academy of Sciences, Professor, Professor of the Department of Obstetrics, Gynecology and Perinatology of the N.V. Sklifosovsky Institute of Clinical Medicine, I.M. Sechenov First Moscow State Medical University, Ministry of Health of the Russian Federation (Sechenov University), +7(499)782-30-45, kafedra-agp@mail.ru, 8-2 Trubetskaya str., Moscow, 119991, Russia.
Irina M. Bogomazova, PhD, Associate Professor of the Department of Obstetrics, Gynecology and Perinatology of the N.V. Sklifosovsky Institute of Clinical Medicine,
I.M. Sechenov First Moscow State Medical University, Ministry of Health of the Russian Federation (Sechenov University), +7(499)782-30-45, Irinka.bogomazova@mail.ru,
8-2 Trubetskaya str., Moscow, 119991, Russia.
Vera S. Belousova, PhD, Associate Professor, Associate Professor of the Department of Obstetrics, Gynecology and Perinatology of the N.V. Sklifosovsky Institute of Clinical Medicine, I.M. Sechenov First Moscow State Medical University, Ministry of Health of the Russian Federation (Sechenov University), +7(499)782-30-45, kafedra-agp@mail.ru, 8-2 Trubetskaya str., Moscow, 119991, Russia.
Elena V. Timokhina, Dr. Med. Sci., Associate Professor, Professor of the Department of Obstetrics, Gynecology and Perinatology of the N.V. Sklifosovsky Institute of Clinical Medicine, I.M. Sechenov First Moscow State Medical University, Ministry of Health of the Russian Federation (Sechenov University), +7(499)782-30-45, kafedra-agp@mail.ru, 8-2 Trubetskaya str., Moscow, 119991, Russia.
Natalia V. Afanasyeva, PhD, Head of the Family Planning Center, S.S. Yudin City Clinical Hospital of the Moscow City Health Department, +7(499)782-30-64,
gkb-yudina@zdrav.mos.ru, 115446, Russia, Moscow, Kolomensky proezd, 4.
Leontina S. Khramova, PhD, obstetrician-gynecologist of the Maternity Hospital, S.S. Yudin City Clinical Hospital of the Moscow City Health Department, +7(499)782-30-64, gkb-yudina@zdrav.mos.ru, 115446, Russia, Moscow, Kolomensky proezd, 4.
Corresponding author: Irina M. Bogomazova, Irinka.bogomazova@mail.ru
Authors’ contributions: Strizhakov A.N., Ignatko I.V., Bogomazova I.M., Timokhina E.V., Belousova V.S. – concept and design of the investigation; Bogomazova I.M., Afanasyeva N.V., Khramova L.S. – material collection and processing; Bogomazova I.M. – writing the text; Strizhakov A.N., Ignatko I.V., Timokhina E.V., Belousova V.S. – editing.
Conflicts of interest: The authors declare that there are no possible conflicts of interest.
Funding: The authors declare that there is no funding.
Patient Consent for Publication. The patient provided informed consent for the publication of her data.
Authors' Data Sharing Statement. The data supporting the findings of this study are available on request from the corresponding author after approval from the principal investigator.
For citation: Strizhakov A.N., Ignatko I.V., Bogomazova I.M., Belousova V.S., Timokhina E.V., Afanasyeva N.V., Khramova L.S. Successful experience with systemic thrombolysis during pregnancy.
Akusherstvo i Ginekologiya/Obstetrics and Gynecology. 2021; 9: 222-226 (in Russian)
https://dx.doi.org/10.18565/aig.2021.9.222-226
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