Massive Pulmonary Embolism During Pregnancy Successfully Treated With Recombinant Tissue Plasminogen Activator: A Case Report and Review of Treatment Options | Pregnancy | JAMA Internal Medicine | JAMA Network
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Review
June 10, 2002

Massive Pulmonary Embolism During Pregnancy Successfully Treated With Recombinant Tissue Plasminogen Activator: A Case Report and Review of Treatment Options

Author Affiliations

From the Department of Medicine, Division of Pulmonary and Critical Care, Duke University Medical Center, Durham, NC.

Arch Intern Med. 2002;162(11):1221-1227. doi:10.1001/archinte.162.11.1221

Thromboembolic disease is an important cause of morbidity and mortality during pregnancy.1 Berg and colleagues2 found that 11% of maternal deaths during pregnancy were related to pulmonary embolism (PE). Another study revealed that up to 40% of pregnant women with asymptomatic deep vein thrombosis (DVT) may also have concurrent PE.3 Women are at increased risk for DVT and PE during pregnancy for several reasons. Pregnancy is a thrombophilic state; fibrinogen levels are increased, and during the final trimester there is a decrease in fibrinolytic activity. In addition, the gravid uterus causes compression and stasis in the lower extremities and pelvic veins favoring thrombosis.3 Finally, women with a history of thrombotic complications during pregnancy have an increased prevalence of genetic mutations related to coagulation.4

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