Massive Pulmonary Embolism During Pregnancy Successfully Treated With Recombinant Tissue Plasminogen Activator

Thromboembolic disease is an important cause of morbidity and mortality during pregnancy. 1 Berg and colleagues 2 found that 11% of maternal deaths during pregnancy were related to pulmonary embolism (PE). Another study revealed that up to 40% of pregnant women with asymptomatic deep vein thrombosis (DVT) may also have concurrent PE. 3 Women are at increased risk for DVT and PE during pregnancy for several reasons. Pregnancy is a thrombophilic state; fibrinogen levels are increased, and during the final trimester there is a decrease in fibrinolytic activity. In addition, the gravid uterus causes compression and stasis in the lower extremities and pelvic veins favoring thrombosis. 3 Finally, women with a history of thrombotic complications during pregnancy have an increased prevalence of genetic mutations related to coagulation. 4