1/89. Catheter-directed thrombolysis for thromboembolic disease during pregnancy: a viable option.Anticoagulation with intravenous heparin has been the standard treatment for the management of gestational thromboembolic complications. Catheter-directed thrombolysis is an encouraging approach for the treatment of thromboembolic disease and has not been previously reported during pregnancy. One gravid woman with pulmonary embolism, critically ill, and hemodynamically compromised, and two gravid women with iliofemoral venous thrombosis, who failed to respond to standard treatment with intravenous heparin, were treated with catheter-directed urokinase. All three patients experienced rapid resolution of symptoms and successful pregnancy outcomes. In our three patients, catheter-directed thrombolysis for thromboembolic disease during pregnancy allowed rapid resolution of hemodynamic abnormalities and/or resolution of thrombus. Catheter-directed thrombolysis offered a reasonably safe alternative to prolonged medical management in these young, otherwise healthy, patients. Long-term, it may prevent the postphlebitic syndrome.- - - - - - - - - - ranking = 1keywords = pregnancy, gestation (Clic here for more details about this article) |
2/89. thrombophlebitis and pulmonary embolism with surgical intervention in the third trimester.A case of acute deep vein thrombophlebitis and pulmonary embolism in late gestation has been presented with a discussion of diagnostic modalities, therapeutic regimens, and theoretical considerations. It is our belief that aggressive medical management is best accomplished by giving heparin intravenously as the primary anticoagulant. When medical management is best accomplished by giving heparin intravenously as the primary anticoagulant. When medical management is not effective or if embolism occurs, surgical intervention, consisting of vena caval clipping and ovarian vein ligation with scrupulous attention to detail, is indicated. Further, support to prophylaxis of abruptio placenta secondary to the mechanism espoused by Mengert et al is added by the course of this patient.- - - - - - - - - - ranking = 0.032086250543387keywords = gestation (Clic here for more details about this article) |
3/89. Recurrent pulmonary emboli and thrombus attached to a permanently implanted pacemaker wire in pregnancy.We present a case of pacer wire thrombus and recurrent pulmonary emboli in pregnancy associated with a permanent pacemaker. Transthoracic echocardiography demonstrated a thrombus attached to the pacer wire at the point where it crossed the tricuspid valve. After the uncomplicated vaginal delivery, thrombolytic therapy was given. This thrombus persisted despite thrombolytic therapy. Consequently, the patient was referred for cardiac surgery. The suspected cause was confirmed during the surgery.- - - - - - - - - - ranking = 0.69136696389758keywords = pregnancy (Clic here for more details about this article) |
4/89. Sudden death from trophoblastic embolism in pregnancy.A case of a 24-year-old multigravida, with dry cough, dyspnea, fatigue, and weight loss with normal foetal growth rate is reviewed. Upon admission the patient suddenly became tachycardic, tachypnoic, cyanotic, followed by a non-palpable peripheral pulse, and asystole unresponsive to resuscitation. The autopsy revealed massive pulmonary trophoblastic embolism, bilateral pregnancy luteoma, and accelerated placental maturation. Trophoblastic embolism should be taken into consideration whenever cardiorespiratory emergency develops during pregnancy.- - - - - - - - - - ranking = 0.8296403566771keywords = pregnancy (Clic here for more details about this article) |
5/89. Thromboembolism during pregnancy. Risks, challenges, and recommendations.pregnancy is an important risk factor for venous thrombosis, and venous thromboembolism is a leading cause of preventable death in pregnancy. diagnosis of venous thromboembolism is complicated in that the symptoms of dyspnea and lower extremity edema are relatively common complaints of pregnant patients. physicians should maintain an appropriately high index of suspicion and request diagnostic imaging in a timely manner. diagnosis of deep venous thrombosis with Doppler ultrasonography of the lower extremity poses no health risk to the fetus, but other radiographic studies pose a low radiation risk to the fetus. Because anticoagulant therapy poses a greater health risk to mother and fetus than does the radiation required for the diagnosis of pulmonary embolism, clinicians should aggressively pursue objective evidence of venous thromboembolism. Once the diagnosis is made, anticoagulation with intravenous unfractionated heparin or subcutaneous low-molecular-weight heparin should be used prepartum followed by warfarin therapy after delivery.- - - - - - - - - - ranking = 0.69136696389758keywords = pregnancy (Clic here for more details about this article) |
6/89. Bilateral jugular venous thromboembolism and pulmonary emboli in a patient with severe ovarian hyperstimulation syndrome.We report here a case of severe ovarian hyperstimulation syndrome with massive ascites in a 25-year-old woman with a history of primary infertility after an IVF-ET cycle. At the 9th gestational week she presented with neck pain and dyspnea and duplex Doppler sonographic examination of the neck veins revealed bilateral jugular venous thrombosis. Despite prompt administration of low-molecular weight heparin, pulmonary emboli developed a few days later.- - - - - - - - - - ranking = 0.032086250543387keywords = gestation (Clic here for more details about this article) |
7/89. Hemorrhagic complication of anticoagulation during pregnancy in a woman with lupus anticoagulant.BACKGROUND: Lupus anticoagulant is an acquired antiphospholipid antibody that can increase greatly the risk of thromboembolism during pregnancy. Because a baseline elevated activated partial thromboplastin time (PTT) is associated frequently with this antibody, monitoring anticoagulant effect with activated PTT can be unreliable. CASE: A pregnant woman with lupus anticoagulant being treated with adjusted dose heparin experienced concurrent severe thrombotic and hemorrhagic complications. CONCLUSION: This case illustrates the pitfall of activated PTT monitoring when administering anticoagulation therapy to a patient with a baseline elevated activated PTT. We propose that heparin levels be used to monitor anticoagulation in these patients.- - - - - - - - - - ranking = 0.69136696389758keywords = pregnancy (Clic here for more details about this article) |
8/89. Protected iliofemoral venous thrombectomy in a pregnant woman with pulmonary embolism and ischemic venous thrombosis.Although thromboembolism is uncommon during pregnancy and the postpartum period, physicians should be alert to the possibility because the complications, such as pulmonary embolism, are often life threatening. pregnant women who present with thromboembolic occlusion are particularly difficult to treat because thrombolysis is hazardous to the fetus and surgical intervention by any of several approaches is controversial. A 22-year-old woman, in her 11th week of gestation, experienced an episode of pulmonary embolism and severe ischemic venous thrombosis of the left lower extremity The cause was determined to be a severe protein s deficiency in combination with compression of the left iliac vein by the enlarged uterus. The patient underwent emergency insertion of a retrievable vena cava filter and surgical iliofemoral venous thrombectomy with concomitant creation of a temporary femoral arteriovenous fistula. The inferior vena cava filter was inserted before the venous thrombectomy to prevent pulmonary embolism from clots dislodged during thrombectomy When the filter was removed, medium-sized clots were found trapped in its coils, indicating the effectiveness of this approach. The operation resolved the severe ischemic venous thrombosis of the left leg, and the patency of the iliac vein was maintained throughout the pregnancy without embolic recurrence. At full term, the woman spontaneously delivered an 8-lb, 6-oz, healthy male infant.- - - - - - - - - - ranking = 0.30863303610242keywords = pregnancy, gestation (Clic here for more details about this article) |
9/89. Treatment of acute pulmonary embolism during pregnancy with low molecular weight heparin: three case reports.We report three patients who presented with acute pulmonary embolism (PE) at gestational weeks 13-19. The diagnosis was based on spiral computer tomography of the lungs. In one of the cases, PE was submassive with signs of right ventricle overload. All of the patients were treated with low molecular weight heparin enoxaparine with an initial dose of 1 mg/kg twice daily during 1 month, and therafter with a reduced dose (80%). The target anti-activated factor x levels 3 h after injection were easily kept in the therapeutic range (0.5-0.9 IU/ml). In all cases, the symptoms were relieved within 4 days and no thrombotic or bleeding complications were observed during the rest of the pregnancy. We conclude that low molecular weight heparin seems to be an efficient and practical treatment of PE during pregnancy.- - - - - - - - - - ranking = 0.86172660722048keywords = pregnancy, gestation (Clic here for more details about this article) |
10/89. Low-molecular weight heparin: treatment failure in a patient with primary antiphospholipid antibody syndrome.Antiphospholipid antibody syndrome is an acquired autoimmune disorder characterized by vascular thrombosis and/or recurrent pregnancy losses along with laboratory evidence of antiphospholipid antibodies. Anticoagulation rather than immunosuppression is the mainstay of treatment. Despite the effectiveness of oral anticoagulation for the prevention of recurrent thromboembolic episodes, thrombotic complications in the setting of apparently therapeutic oral anticoagulation have been observed; this may at times be due to difficulties in maintaining a consistently therapeutic level of anticoagulation. Low-molecular-weight heparin has been a useful alternative for long-term anticoagulation when there is difficulty in managing oral anticoagulant therapy and has the advantage of a consistent anticoagulant effect. In this report, we describe a woman with primary antiphospholipid antibody syndrome who developed extensive pulmonary embolism despite receiving a proven therapeutic dosage of low molecular weight heparin.- - - - - - - - - - ranking = 0.13827339277952keywords = pregnancy (Clic here for more details about this article) |
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