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Pulmonary Emboli Manifestation during Spinal Anesthesia for Cesarean Section in two Pregnant Women

Mastaneh Dahi, Seyed Amir Mohajerani
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Abstract

Background: Pregnancy causes a small increase in risk of venous thromboembolism (VTE), but a large increase in concern upon presentation during cesarean section with symptoms of pulmonary embolism (PE). Pulmonary embolism clinical manifestations during spinal anesthesia could be misleading. We have presented 2 interesting cases of pregnant women underwent spinal anesthesia for cesarean section and manifested with non-specific clinical symptoms of PE during spinal anesthesia mistaken for high spinal scenarios.

Cases Report: Two young pregnant women candidate for cesarean section underwent spinal anesthesia. During surgery, patient grows chest discomfort and dyspnea. Anesthesiologist misleaded for high spinal but observed patients during surgery and in recovery. Further investigation detected pulmonary embolism which was further treated in ICU and patients were discharged subsequently.

Conclusion: Anesthesiologists cannot safely rule out pulmonary embolism during spinal anesthesia in cesarean section without additional testing, at least not in pregnant women with a relatively high risk of PE.


Keywords

Pulmonary emboli, spinal anesthesia, pregnancy

References

Kline JA, Richardson DM, Than MP, Penaloza A, Roy PM.Systematic review and meta-analysis of pregnant patients investigated for suspected pulmonary embolism in the emergency department. Acad Emerg Med. 2014 Sep;21(9):949-59. doi: 10.1111/acem.12471.

Lee MY, Kim MY, Han JY, Park JB, Lee KS, Ryu HM.Pregnancy-associated pulmonary embolism during the peripartum period: An 8-year experience at a single center. Obstet Gynecol Sci. 2014 Jul;57(4):260-5.

Wittenberg R, Berger FH, Peters JF, Weber M, van Hoorn F, Beenen LF, van Doorn MM, van Schuppen J, Zijlstra IA, Prokop M, Schaefer-Prokop CM. Acute Pulmonary Embolism: Effect of a Computer-assisted Detection Prototype on Diagnosis--An Observer Study.Radiology. 2012 Jan;262(1):305-13.

Boiselle PM, Goodman LR, Litmanovich D, Rémy-Jardin M, Schaefer-Prokop C. Expert Opinion: CT Pulmonary Angiography in Pregnant Patients With Suspected Pulmonary Embolism. J Thorac Imaging. 2012 Jan;27(1):5.

Coutance G, Cauderlier E, Ehtisham J, Hamon M, Hamon M. The prognostic value of markers of right ventricular dysfunction in pulmonary embolism: a meta-analysis. Crit Care. 2011;15(2):R103.

Janata K, Höchtl T, Wenzel C, Jarai R, Fellner B, Geppert A, Smetana P, Havranek V, Huber K. The role of ST-segment elevation in lead aVR in the risk assessment of patients with acute pulmonary embolism.Clin Res Cardiol. 2011 Dec 22.

Hirai LK, Takahashi JM, Yoon HC. A prospective evaluation of a quantitative D-dimer assay in the evaluation of acute pulmonaryembolism. J Vasc Interv Radiol. 2007 Aug;18(8):970-4.

Gabriel S.Re: A Prospective Evaluation of a Quantitative D-dimer Assay in the Evaluation of Acute Pulmonary EmbolismJournal of Vascular and Interventional Radiology. 2008 Dec; 19(12): 1792-1793.

Raja AS, K Ip I, M Prevedello L, D Sodickson A, Farkas C, D Zane R, Hanson R, Z Goldhaber S, Gill RR, Khorasani R. Effect of Computerized Clinical Decision Support on the Use and Yield of CT Pulmonary Angiography in the Emergency Department.Radiology. 2011 Dec 20.

Gonzalez L.Pulmonary embolism in pregnancy. Acute Med. 2014;13(1):49.

Waldman M1, Sheiner E, Sergienko R, Shoham-Vardi I.Can we identify risk factors during pregnancy for thrombo-embolic events during the puerperium and later in life? J Matern Fetal Neonatal Med. 2014 Jul 31:1-5.

Astani SA, Davis LC, Harkness BA, Supanich MP, Dalal I. Detection of pulmonary embolism during pregnancy: comparing radiation doses of CTPA andpulmonary scintigraphy.Nucl Med Commun. 2014 Jul;35(7):704-11.

Kukla P, Długopolski R, Krupa E, Furtak R, Szełemej R, Mirek-Bryniarska E, Jastrzębski M, Nowak J, Wańczura P, Bryniarski L. Electrocardiography and prognosis of patients with acute pulmonary embolism.Cardiol J. 2011;18(6):648-53.

Sanchez O, Trinquart L, Colombet I, Durieux P, Huisman MV, Chatellier G, Meyer G. Prognostic value of right ventricular dysfunction in patients with haemodynamically stablepulmonary embolism: a systematic review. Eur Heart J. 2008 Jun;29(12):1569-77.

Meng K, Hu X, Peng X, Zhang Z.Incidence of venous thromboembolism during pregnancy and the puerperium: a systematic review and meta-analysis.J Matern Fetal Neonatal Med. 2014 May 7:1-9.




DOI: https://doi.org/10.22037/nbm.v3i1.7589