Background: Pulmonary embolism is one of the most common causes of maternal mortality and can be classified into low-risk, submassive, and massive. Three treatment options exist for massive pulmonary embolism in nonpregnant patients: thrombolysis, percutaneous catheter-based embolectomy, or surgical embolectomy; however, there is limited evidence to guide management of pulmonary embolism in pregnancy.
Case: We present a case of massive pulmonary embolism in pregnancy. Our patient presented with pulmonary embolism with biomarker and imaging evidence of right heart strain. She developed hypotension and an increased oxygen requirement and was subsequently treated with ultrasound-assisted catheter-directed thrombolysis. She was discharged on low-molecular-weight heparin and had a normal spontaneous vaginal delivery at 39 weeks of gestation.
Conclusions: Catheter-directed thrombolysis is preferred to systemic thrombolytic therapy in pregnant patients with massive pulmonary embolism requiring thrombus removal.