Successful use of tissue plasminogen activator (t-PA) for maternal pulmonary embolism with cardiopulmonary collapse during perinatal period: report of 2 cases.
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Pulmonary embolism that occurs from delivery to the puerperium often develops into maternal respiratory and circulatory collapse. The patients described here developed pulmonary embolism in association with cesarean section and was successfully treated by thrombolytic therapy. Case 1, a 34-year-old 1-parous, was transferred to our hospital with a diagnosis of PIH at 29 weeks and 4 days of pregnancy. Cesarean section revealed premature separation of the placenta. Respiratory and circulatory insufficiency was noted intraoperatively, and pulmonary embolism was suspected. Since heparin was ineffective, tissue plasminogen activator (t-PA) was administered, resulting in a rapid relief. Postoperatively, massive hemorrhage was observed intraperitoneally and through the drain due to the occurrence of DIC, and laparotomy was performed again after 38 hours, and hemorrhage from the suture site of the abdominal wall was stopped by ligation. Case 2 was 38 years old and was admitted due to preeclampsia accompanied by hydramnion. Fetal distress developed during 1-week hospitalization, and cesarean section was performed at 35 weeks and 4 days of pregnancy. The patient developed respiratory and circulatory collapse while walking on the third postoperative day. Pulmonary thrombosis was suspected, but urokinase was ineffective, and remission was obtained by the administration of t-PA. However, collapse recurred after 8 hours due to intraperitoneal hemorrhage, and laparotomy was performed again. Since hemorrhage was noted from a tear in the capsule of liver, hemostasis was made by suturing. t-PA was shown to be effective for critical conditions suspected to be caused by severe pulmonary embolism accompanied by shock that resists ordinary thrombolytic agents. However, the timing, method, or dosage of t-PA administration for pulmonary embolism with the possibility of consequent hemorrhagic tendency have not been established, and careful evaluation of indications is considered to be needed before the use of t-PA in the perioperative period. [Adv. Obstet. Gynecol., 52 (6): 792-797, 2000 (H.12.11)]
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