Abstract
Introduction Pulmonary embolism (PE) is associated with approximately 10.5% of maternal deaths
in the United States. Despite heightened awareness of its mortality potential, there
islittle data available to guide its management in pregnancy. We present the case
of a massive PE during gestation successfully treated with catheter-directed embolectomy.
Case Presentation A 37-year-old G2P1001 presented with a syncopal episode preceded by dyspnea and chest
pain. Upon presentation, she was hypotensive, tachycardiac, and hypoxic. Imaging showed
an occlusive bilateral PE, right heart strain, and a possible intrauterine pregnancy.
Beta-human chorionic gonadotropin was positive. She was taken emergently for catheter-directed
embolectomy. Her condition immediately improved afterward. Postprocedure pelvic ultrasound
confirmed a viable intrauterine pregnancy at 10 weeks gestation. She was discharged
with therapeutic enoxaparin and gave birth to a healthy infant at 38 weeks gestation.
Conclusion Despite being the gold standard for PE treatment in nonpregnant adults, systemic
thrombolysis is relatively contraindicated in pregnancy due to concern for maternal
or fetal hemorrhage. Surgical or catheter-based thrombectomies are rarely recommended.
Limited alternative options force their consideration, particularly in a hemodynamically
unstable patient. Catheter-directed embolectomy can possibly bypass such complications.
Our case exemplifies the consideration of catheter-directed embolectomy as the initial
treatment modality of a hemodynamically unstable gestational PE.
Keywords
thrombectomy - embolectomy - thrombolytic therapy - pregnancy - pulmonary embolism
