Extensive pulmonary embolism after severe postpartum haemorrhage: management with an inferior vena cava filter

Abstract

We report the case of a 36-year-old woman with an inferior vena cava thrombosis and extensive pulmonary embolism six days after a severe postpartum haemorrhage. She had undergone caesarean section with bleeding managed by massive transfusion, hysterectomy, and two attempts at uterine artery embolization. Systemic thrombolysis and catheter-directed thrombolysis in intensive care were abandoned due to recent and incomplete uterine artery embolization. A temporary inferior vena cava filter was chosen because of significant risk of massive pulmonary embolism. This was a controversial decision because guidelines from different professional groups offer conflicting recommendations. The therapeutic options for the management of massive postpartum pulmonary embolism when thrombolysis is contraindicated are discussed.

Keywords: IVC filter; Inferior vena cava thrombus; Pregnancy; Pulmonary embolism.