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KMID : 0390619980060010100
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Journal of Cardiovascular Ultrasound
1998 Volume.6 No. 1 p.100 ~ p.105
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Two Cases of Acute Pulmonary Embolism After Cesarean Section Confirmed by Echocardiography
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Kim Woo-Shik
Cho Jin-Man
Kang Heung-Sun
Choue Chung-Whee
Kim Kwon-Sam
Song Jung-Sang
Bae Jong-Hoa
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Abstract
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In the past 60 years the maternal mortality rate has declined markedly. Nevertheless, death associated with childbirth is still a major public health problem. For women delivered of live infants, the leading causes of mortality are acute pulmonary embolism(mostly thromboembolic), pregnancy-induced hypertension, hemorrhage, and infection. Currently, the common cause of maternal mortality are pulmonary embolism. Though acute pulmonary embolism is a potentially fatal disorder, when properly diagnosed and treated, clinically apparent pulmonary embolism was an uncommon cause of death. However, the diagnosis of acute pulmonary embolism is still a challenge for clinicians because of its nonspecific and variable clinical features. Pulmonary angiography, admittedly the ’gold standard’ technique for this diagnosis, is costly, invasive, and not universally available. Noninvasive procedures such as lung scan has certainly simplified the diagnostic approach. However, lung scan is diagnostic in only 30 to 50% of patients, and many institutions lack nuclear medicine facilities. Thus, alernative imaging techniques are needed for the noninvasive diagnosis of pulmonary embolism. Echocradiography is rapid, practical and sensitive technique for the identification of right ventricular overload following acute pulmonary embolism. Echocardiographic identification of patients with right ventricular dysfunction is important because aggressive intervention with thrombolytics, certain inotropic and vasoactive agents, or embolectomy may improve outcome. We report herein two cases of acute pulmonary embolism after cesarean section. Certain clinical findings, hemodynamic values, and particularly, echocardiographic signs can indentify right ventricular dysfunction after pulmonary embolism. The patients was immediately treated with intravenous heparin and inotropic support, which induced a rapid improvement of the clinical and hemodynamic parameters.
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KEYWORD
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Acute pulmonary embolism, Cesarean section, Echocardiography
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