Unseen face of the pregnancy: pulmonary embolism, cardiac arrest, liver laceration

Introduction: Pulmonary embolism (PE) is more common in pregnant women, especially after a caesarean section. The risk is increased over first 6 weeks of the postpartum period, being up to 60 times higher compared with the risk in non-pregnant women. Clini-cal cardiopulmonary arrest (CPA) as first symptom is rare but may have catastrophic consequences.
Case presentation: We present the case of a 20-year-old puerperal woman who installs CPA at 5 hours post caesarean delivery. Caesarean section was done without complications. After restoring sinus rhythm, computer tomography (CT) confirms pulmonary embolism (PE). Additional assessment of the abdominal region has de-tected left lobe liver laceration with an intraparenchymatous hematoma and right Antopol-Goldman lesion, without rupture thus heparinotherapy was delayed. Stationary aspect of haematoma suggest the integrity of the Glisson’s capsule and the anticoagulant treatment was started with unfractionated heparin (HNF). At 3 months after discharge, thoraco-abdominal CT scan showed only residual tiny hepatic scar, without PE signs.
Conclusions: Current guidelines do not include re-commendations for all situations, hence multidisciplinary approach of a case with high mortality risk may evaluate therapeutic options appropriately. PE, CPA and liver laceration attribute this patient a poor prognosis by direct association of these comorbidities and by limiting therapeutic options.

ISSN – online: 2734 – 6382
ISSN-L 1220-658X
ISSN – print: 1220-658X
The Romanian Journal of Cardiology is indexed by:
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CODE: 379
CME Credits: 10 (Romanian College of Physicians)