Year 2021, Volume 3 , Issue 2, Pages 88 - 90 2021-07-01

Acil Serviste Trombolitik Tedavi Uygulanan Gebe Hastada Massif Akut Pulmoner Emboli
Massive Acute Pulmonary Embolism in A Pregnant Patient Who Underwent Thrombolytic Treatment in Emergency Service

Sema BAYRAK [1] , Vildan ÖZER [2] , Selman YENİOCAK [3]


Akut pulmoner emboli (APE), gebelik döneminde en önemli önlenebilir ölüm nedenlerinden birisidir. Bu yazıda APE tanısı alan ve trombolitik tedavi uygulanan 24 haftalık gebe bir hastayı litaratür eşliğinde tartışılmıştır. Gebe olan 27 yaşındaki bayan hasta, ani başlayan nefes darlığı ve göğüs ağrısı şikayetleriyle acil servise müracaat etti. Kan tetkik sonuçları gebelikteki fizyolojik değişikliklerle karışması nedeniyle yol gösterici olmadı, yapılan bilateral alt ekstremite venöz doppler ultrasonografi (USG)’de tromboz izlenmedi. Hastanın hemodinamik durumu unstabil olduğundan radyoloji ünitesinde herhangi bir görüntüleme yapılamadı. Yatakbaşı transtorasik ekokardiyografi (EKO)’de sağ ventrikül yüklenme bulguları görülmesi sonucu massif APE tanısı konularak trombolitik tedavi uygulandı. APE, hemodinamik olarak unstabil olan hastalarda kardiyovasküler acil durumların en yaygın nedenlerinden birisi olup, çok mortal seyreder. Ani başlayan nefes darlığı ve göğüs ağrısı şikayetleriyle acil servise başvuran hastalarda, mutlaka APE düşünülmelidir. Radyoloji ünitesinde görüntüleme yapılamayacak kadar unstabil olan hastalar, hızlıca yatakbaşı transtorasik EKO ile massif emboli açısından değerlendirilmelidir.
Acute pulmonary embolism (APE) is one of the most important preventable mortality causes during pregnancy. In this case report, a 24-week pregnant patient who were diagnosed with APE and who underwent thrombolytic treatment was discussed in the light of a literature review. The 27-year-old female patient, who was pregnant, applied to the emergency service with sudden shortness of breath and chest pain. Since the hemodynamic condition of the patient was unstable, no imaging could be carried out in the radiology unit. As a result of the right ventricular load symptoms detected in bedside Transthoracic Echocardiography (ECO), massive APE was diagnosed, and thrombolytic treatment was initiated. APE should be considered in patients who are admitted to emergency services with sudden shortness of breath and chest pain complaints. Patients who are excessively unstable for imaging in the radiology unit should be evaluated quickly with bedside transthoracic ECO in terms of massive embolism.
  • Referans1. Mac KAP, Berg CJ, Liu X, Duran C, Hoyert DL. Changes in pregnancy mortality ascertainment: United States, 1999-2005. Obstetrics and gynecology 2011; 118(1): 104-10.
  • Referans2. Pillny M, Sandmann W, Luther B, Muller BT, Tutschek B, Gerhardt A, et al. Deep venous thrombosis during pregnancy and after delivery: indications for and results of thrombectomy. Journal of vascular surgery 2003; 37(3): 528-32 .
  • Referans3. Bremme KA. Haemostatic changes in pregnancy. Best practice & research Clinical haematology 2003; 16(2): 153-68.
  • Referans4. Rey E, Kahn SR, David M, Shrier I. Thrombophilic disorders and fetal loss: a meta-analysis. Lancet 2003; 361: 901-8.
  • Referans5. Leung AN, Bull TM, Jaeschke R, Lockwood CJ, Boiselle PM, et al. An official American Thoracic Society/Society of Thoracic Radiology clinical practice guideline: evaluation of suspected pulmonary embolism in pregnancy. Am J Respir Crit Care Med 2011; 184(10): 1200-8.
  • Referans6. Bozorgmehr R, Pishgahi M, Mohaghegh P, Bayat M, Khodadadi P, et al. Relationship between Thrombosis Risk Factors, Clinical Symptoms, and Laboratory Findings with Pulmonary Embolism Diagnosis; a Cross-Sectional Study. Arch Acad Emerg Med 2019; 7(1): 41.
  • Referans7. Kovac M, Mikovic Z, Rakicevic L, Srzentic S, Mandic V, et al. The use of D-dimer with new cutoff can be useful in diagnosis of venous thromboembolism in pregnancy. Eur J Obstet Gynecol Reprod Biol 2010; 148(1): 27-30.
  • Referans8. Yaşar Z, Talay F. The Management of Tromboembolic Diseases in Pregnancy. Abant Medical Journal 2015; 4(3): 302-8.
  • Referans9. Winer-Muram HT, Boone JM, Brown HL, Mabie WC, Lombardo GT. Pulmonary embolism in pregnant patients: fetal radiation dose with helical CT. Radiology 2002; 224: 487-92.
  • Referans10. International Conference on Harmonisation; draft guidance on E2F Development Safety Update Report; availability. Notice. Fed Regist 2008; 73(151): 45462-3.
  • Referans11. Rodrigues AC, Guimaraes L, Guimaraes JF, Monaco C, Cordovil A, et al. Relationship of clot burden and echocardiographic severity of right ventricular dysfunction after acute pulmonary embolism. Int J Cardiovasc Imaging 2015; 31(3): 509-15.
  • Referans12. Konstantinides SV, Torbicki A, Agnelli G, Danchin N, Fitzmaurice D, et al. 2014 ESC guidelines on the diagnosis and management of acute pulmonary embolism. Eur Heart J 2014; 35: 3033-69.
Primary Language en
Subjects Emergency Medicine
Journal Section Case Reports
Authors

Orcid: 0000-0002-6107-1502
Author: Sema BAYRAK (Primary Author)
Institution: KARADENİZ TEKNİK ÜNİVERSİTESİ
Country: Turkey


Orcid: 0000-0002-2514-5674
Author: Vildan ÖZER
Institution: KARADENİZ TEKNİK ÜNİVERSİTESİ
Country: Turkey


Orcid: 0000-0002-1124-396X
Author: Selman YENİOCAK
Institution: İSTANBUL HASEKİ EĞİTİM ARAŞTIRMA HASTANESİ
Country: Turkey


Dates

Application Date : December 20, 2020
Acceptance Date : February 11, 2021
Publication Date : July 1, 2021

AMA Bayrak S , Özer V , Yeniocak S . Massive Acute Pulmonary Embolism in A Pregnant Patient Who Underwent Thrombolytic Treatment in Emergency Service. Phnx Med J.. 2021; 3(2): 88-90.