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2026 SOAP Annual Meeting
April 29 - May 3, 2026 | Montreal, Quebec Canada
2337164
From Triage to Delivery Planning: Management After Massive Pulmonary Embolism
Poster Presenter
Authors
Part of Topic
CAN'T DO A NEURAXIAL?
Background
•Pulmonary Embolism (PE) is a leading cause of maternal morbidity and mortality.
•2/2 hypercoagulability & venous stasis 2/2 pregnancy, major PE w/ RV dysfxn is an obstetric emergency and delayed treatment can be fatal.
•Systemic thrombolysis is recommended for HD unstable PE; however, use in pregnancy is rare 2/2 a lack of Rx and guidance is largely anecdotal.
•PE poses unique challenges for obstetric anesthesiologists who must rapidly coordinate care and anticipate sequelae.
Case Description
•41-y-o G6P2123 @ 29 weeks presents with syncope, hypotension, tachycardia, hypoxemia.
•POC TTE: RV strain & McConnell’s sign. CTA: B/L mainstem PE & RV dilation, interventricular septal flattening.
•½-dose systemic alteplase (50 mg) in L&D triage, f/b heparin infusion and inotropes. Tx to 3º center for potential ECMO. Oxygenation and RV fxn improved, -> weaning of vasoactive agents and txn to therapeutic LMWH. Serial TTE: normalization of RV function and fetal status remained stable
•Subsequent normalization of coagulation: scheduled CD under CSE without complication.
Discussion
•This case highlights the role of obstetric anesthesiologists in the management of pregnancy-associated PE.
•POCUS was critical for rapid diagnosis and risk stratification.
•ACOG states that pregnancy is not an absolute CI to thrombolysis when a PE is life-threatening.
•Despite minimal placental transfer, alteplase carries a risk of fetal compromise indirectly through placental or uterine bleeding leading to uteroplacental hypoperfusion.