A case of pulmonary embolism after cesarean delivery in a woman complicated uterine leiomyoma

• Published in: Journal of Japan Society of Perinatal and Neonatal Medicine Vol. 57; no. 1; pp. 129 - 134
• Main Authors: Sho, Takanari, Maeda, Takatsugu, Toda, Kaori, Kirihara, Nami, Taniguchi, Hiroko, Kamitomo, Masato
• Format: Journal Article
• Language: Japanese
• Published: Japan Society of Perinatal and Neonatal Medicine 2021
• Subjects: Cesarean section; Leiomyoma; Pregnancy; Pulmonary embolism
• ISSN: 1348-964X; 2435-4996
• DOI: 10.34456/jjspnm.57.1_129

Although uterine leiomyomas can cause various obstetric complications during pregnancy, few reports have described venous thromboembolism during pregnancy associated with uterine leiomyomas. We present a case of a pregnant woman with a uterine leiomyoma who developed pulmonary embolism（PE）after cesarean section and was successfully treated with intensive care, including cardiopulmonary support. A 36-year-old primigravida woman with a giant leiomyoma of approximately 14cm in diameter was referred to our hospital. Cesarean section was performed because of arrest of labor. On postoperative day（POD）1, cardiopulmonary arrest occurred during the first ambulation, and we started chest compression. We strongly suspected PE and used tracheal intubation and venoarterial extracorporeal membrane oxygenation（VA-ECMO）（percutaneous cardiopulmonary support［PCPS］）. Contrast-enhanced computed tomography（CT）revealed PE. No thrombus was observed in the pelvic vein, but the inferior vena cava was compressed by the enlarged uterus. The patient was discharged on POD 34 without major complications. PE should be suspected in patients with postoperative cardiac arrest if they have giant uterine leiomyomas. Early diagnostic imaging using enhanced CT and intensive care with immediate application of VA-ECMO（PCPS） are believed to be crucial for successful treatment in this case. In addition, it is important to evaluate for thrombus, including coagulation function testing, and administer perioperative prophylactic anticoagulation therapy for pregnant women with giant uterine leiomyomas.