Jiang L, Liang WX, Yan Y, Wang SP, Dai L, Chen DJ. Thrombotic pulmonary embolism of inferior vena cava during caesarean section: A case report and review of the literature. World J Clin Cases 2022; 10(13): 4226-4235 [PMID: 35665114 DOI: 10.12998/wjcc.v10.i13.4226]
Corresponding Author of This Article
Dun-Jin Chen, MD, PhD, Chief Doctor, Department of Obstetrics and Gynecology, The Third Affiliated Hospital of Guangzhou Medical University, No. 63 Duobao Road, Guangzhou 510015, Guangdong Province, China. gzdrchen@gzhmu.edu.cn
Research Domain of This Article
Obstetrics & Gynecology
Article-Type of This Article
Case Report
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Clin Cases. May 6, 2022; 10(13): 4226-4235 Published online May 6, 2022. doi: 10.12998/wjcc.v10.i13.4226
Thrombotic pulmonary embolism of inferior vena cava during caesarean section: A case report and review of the literature
Lan Jiang, Wei-Xiang Liang, Yi Yan, Shou-Ping Wang, Li Dai, Dun-Jin Chen
Lan Jiang, Wei-Xiang Liang, Li Dai, Department of Medical Ultrasound, The Third Affiliated Hospital of Guangzhou Medical University, Guangzhou 510150, Guangdong Province, China
Yi Yan, Department of Cardiology, The Third Affiliated Hospital of Guangzhou Medical University, Guangzhou 510150, Guangdong Province, China
Shou-Ping Wang, Department of Anesthesiology, The Third Affiliated Hospital of Guangzhou Medical University, Guangzhou 510015, Guangdong Province, China
Dun-Jin Chen, Department of Obstetrics and Gynecology, The Third Affiliated Hospital of Guangzhou Medical University, Guangzhou 510015, Guangdong Province, China
Author contributions: Jiang L performed the echocardiography, reviewed the literatures and contributed to manuscript drafting; Liang WX and Yan Y reviewed and modified the manuscript; Wang SP collated clinical data; Dai L analyzed and interpreted the imaging; Chen DJ was responsible for the revision of the manuscript for important intellectual content; all authors read the final manuscript.
Supported bythe National Natural Science Foundation of China, No. 81870320; and the Health Science and Technology Project of Guangzhou, No. 20191A011086.
Informed consent statement: Informed written consent was obtained from the patients for the publication of this report and any accompanying images.
Conflict-of-interest statement: The authors declare that they have no conflict of interest.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Dun-Jin Chen, MD, PhD, Chief Doctor, Department of Obstetrics and Gynecology, The Third Affiliated Hospital of Guangzhou Medical University, No. 63 Duobao Road, Guangzhou 510015, Guangdong Province, China. gzdrchen@gzhmu.edu.cn
Received: September 23, 2021 Peer-review started: September 23, 2021 First decision: January 10, 2022 Revised: January 21, 2022 Accepted: March 16, 2022 Article in press: March 16, 2022 Published online: May 6, 2022 Processing time: 218 Days and 18.9 Hours
Abstract
BACKGROUND
Thrombotic pulmonary embolism (TPE) is one of the most critical diseases in obstetrics but is rarely reported in caesarean section (CS) because TPE patients in CS have a high risk of death and are difficult to diagnose. This case report of TPE during CS was recorded by transthoracic echocardiography (TTE) and can provide a reference for the differential diagnosis of critical illnesses in CS.
CASE SUMMARY
A 37-year-old pregnant woman with rheumatic heart disease (RHD), gravida 5 and para 1 (G5P1), presented for emergency CS at 33 wk and 3 d of gestation under general anesthesia because of acute heart failure, pulmonary hypertension and arrhythmia. After placental removal during CS, TTE revealed a nascent thrombus in the inferior vena cava (IVC) that elongated, detached and fragmented leading to acute thromboembolic events and acute TPE. This report presents the whole process and details of TPE during CS and successful rescue without any sequelae in the patient. This case gives us new ideas for the diagnosis of death or cardiovascular accidents during CS in pregnant women with heart disease and the detailed presentation of the rapid development of TPE may also elucidate new ideas for treatment. This case also highlighted the importance of prophylactic anticoagulation in the management of heart disease during pregnancy.
CONCLUSION
Pregnancy with heart failure could trigger inferior vena cava (IVC)-origin TPE during CS. Detection and timely treatment can avoid serious consequences.
Core Tip: Thrombotic pulmonary embolism (TPE) is one of the most critical diseases in obstetrics but is rarely reported in caesarean section (CS), especially thrombus originating from the inferior vena cava. This case report describes a 37-year-old pregnant woman with rheumatic heart disease who developed TPE during CS and recorded the whole process by transthoracic echocardiography. This case provided experience for the differential diagnosis of amniotic fluid embolism in CS. This case also reminds us of the importance of pregnancy management and prophylactic anticoagulants in pregnant women with heart disease, and if not, an intensive care team is needed to ensure patient safety.
