On the evening of June 29, Tu Du Hospital said that the unit had coordinated with Cho Ray Hospital to successfully treat pregnant woman T.V (27 years old, Ho Chi Minh City) with acute pulmonary embolism after a cesarean section.
Throughout her pregnancy, Ms. V was monitored periodically and no abnormalities were recorded. On June 17, at 39 weeks and 5 days of gestation, Ms. V was indicated for a cesarean section due to abnormal fetal heartbeat on the background of ruptured membranes. The baby girl was born healthy, weighing 3,100 g, rosy and crying well.
3 days after surgery, Ms. V's health was almost completely recovered, eating and urinating were normal, the surgical wound was dry, no fever. However, on the afternoon of June 19, Ms. V suddenly became very tired and fainted. The medical team performed resuscitation to prevent shock.
At this time, the patient fell into respiratory failure with SpO2 remaining only 86%, blood pressure dropping to 85/50 mmHg, heartbeat fast and irregular. The electrocardiogram recorded rapid atrial fibrillation responding to ventricular fibrillation about 220 times/minute, accompanied by abnormal QRS complex. The patient was diagnosed with arrhythmia, atrial fibrillation monitoring and was quickly transferred to the Intensive Care Unit for active treatment.
The patient's condition continued to progress severely with symptoms of dizziness, cyanosis, sweating, blood pressure only 60/40 mmHg. Doctors urgently used vasopressors, cardiac drugs and treated arrhythmia.
Bedside cardiac ultrasound detected blood clots in the right heart chamber, accompanied by right ventricular dilation, mild pulmonary hypertension and moderate tricuspid valve regurgitation. Underarm Doppler blood vessel ultrasound also recorded right hamstring venous blood clots.
Tu Du Hospital held an emergency consultation with cardiology experts from Cho Ray Hospital. The patient was diagnosed with very high-risk pulmonary embolism and agreed to be urgently transferred to the hospital to deploy VA-ECMO.
After being safely transferred to the Emergency Resuscitation Department of Cho Ray Hospital, the patient quickly fell into a state of hemodynamic instability. Doctors performed cardiopulmonary resuscitation and established VA-ECMO emergency.
In particular, the patient was maintained according to the Awake ECMO model, without needing endotracheal intubation, contributing to limiting the risk of lung damage and related complications. After 48 hours of intensive treatment, the hemodynamic status gradually stabilized and the patient overcame the critical stage.
After 5 days of treatment, Ms. V's health improved. On June 24, the patient underwent surgery to remove pulmonary artery blood clots and continued to receive ECMO circulation support for another 4 days.
By the morning of June 29, the patient was almost fully recovered, stopped ECMO, stopped vasopressors, self-ventilated, continued antifreeze treatment and is expected to be discharged in the next 1-2 days.
Postpartum pulmonary embolism - Rare but dangerous complication
Pulmonary embolism is one of the serious obstetric complications, which can appear suddenly during pregnancy or postpartum with very rapid progression if not detected and treated promptly.
Ms. V's case shows the particularly important role of early identification of abnormal signs, accurate diagnosis, timely treatment as well as effective coordination between many specialties and many hospitals in emergency treatment of critical cases.
