Pulmonary embolism during pregnancy is the most dreaded medical condition. It is one of the most prominent causes of maternal mortality in developed countries. Pulmonary embolism is defined as obstruction of pulmonary artery in the lung. Blockage mainly results from a blood clot that migrates from a site outside the lungs in a pregnant woman.
Pulmonary embolism is not a disease but a complication resulting from deep vein thrombosis in most cases.Primary source of blood clot (embolus) arises from deep veins of legs in pregnancy. Various changes in the body occur in pregnancy, which predispose for developing a blood clot in deep veins of the legs as well as the deep veins of pelvis.
Symptoms include shortness of breath, pain in chest, foamy red cough tinged with blood etc. Once diagnosed this condition needs to be treated with blood thinning medicines such as heparin or low molecular weight heparin.
Symptoms Of Pulmonary Embolism
Pulmonary embolism in pregnant women mainly develops due to deep vein thrombosis in the leg. Together with the symptoms of pulmonary embolism, patient may also have symptoms of deep vein thrombosis. The symptoms of pulmonary embolism can be mild or severe depending on the amount of blockage and the area of the lung involved.
Mild cases of pulmonary embolism are frequently missed or misdiagnosed due to paucity of striking symptoms and signs. Massive pulmonary embolism is far more dramatic and the symptoms are severe.
Here are symptoms of mild pulmonary embolism:
- Unexplained low grade fever.
- Constriction in chest or pain in chest.
- Sudden rapid heartbeats.
- Low blood pressure
- Transient fainting
- Spitting of blood
Symptoms of massive pulmonary embolism:
- Severe pain in middle of chest.
- Pain is accompanied with difficulty in breathing.
- Profuse sweating.
- Cold and clammy extremities.
- Blue color of tongue, lips, ears, and nails.
- Loss of consciousness.
The symptoms of deep vein thrombosis in leg are frequently present. The significant symptoms of DVT are:
- Tenderness in calf muscles.
- Pain in calf with every movement.
- Superficial vein becomes hard to feel.
- Rise of skin temperature of the affected leg.
- Swelling of the affected leg.
One or more than one sign is apparent on examination in fifty percent of woman suffering from pulmonary embolism.
Causes Of Pulmonary Embolism During Pregnancy
Pulmonary embolism as mentioned earlier is caused due to obstruction in the pulmonary artery in the lung. It is mainly from a migrated blood clot from leg or anywhere else other than the lung. One of the reasons greatly responsible for pulmonary embolism is deep vein thrombosis in leg. A clot from the leg vein detaches and moves up to the pulmonary artery through the blood.
In pregnancy there are several alterations in the body. This increases the risk of developing deep vein thrombosis in legs. Blood changes, uterus enlargement, changed clotting mechanism, etc play important role in deep vein thrombosis and consequently its complication in the form of pulmonary embolism.
At least 1 in 3000 pregnant women may have pulmonary embolism and about 1 in 100000 die due to pulmonary embolism during pregnancy. Certain factors increase the risk of pulmonary embolism during pregnancy. These factors are:
- Multiple pregnancies
- Cesarean section
- Sedentary lifestyle
- Women above the age of 35.
- Blood disorder and thrombofilia.
- Family history of embolism.
Treatment For Pulmonary Embolism
With proper diagnosis and appropriate treatment mortality from pulmonary embolism is significantly reduced. Ultrasound and Doppler studies are diagnostic choice which helps to find the damage and amount of obstruction. Besides this tests are safe during pregnancy.
The main aim of treatment is to prevent the clot to enlarge in size and secondly to prevent formation of newer clots. In case of severe pulmonary embolism, patient is treated in a medical emergency unit. The treatment will depend of how severe are the symptoms. Anticoagulant medicines such as heparin and low molecular weight heparin are found effective in treating the condition.