A case of pulmonary thromboembolism caused by hyperemesis gravidarum, successfully treated using recombinant tissue plasminogen activator at 13 weeks of pregnancy

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  • MATSUBARA Sho
    Department of Obstetrics and Gynecology, Osaka Habikino Medical Center
  • YASUKAWA Hisayoshi
    Department of Obstetrics and Gynecology, Osaka Habikino Medical Center
  • OGAWA Kenji
    Department of Obstetrics and Gynecology, Osaka Habikino Medical Center
  • NAGAI Akira
    Department of Obstetrics and Gynecology, Osaka Habikino Medical Center
  • HIRAMATSU Keizo
    Hiramatsu Obstetrics and Gynecology Clinic
  • AKADA Shinobu
    Department of Obstetrics and Gynecology, Osaka Habikino Medical Center

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Other Title
  • 妊娠悪阻に合併した肺血栓塞栓症に対し,妊娠13週で遺伝子組み換え組織プラスミノゲンアクチベーター静注療法を施行し,生児を得た1例
  • 症例報告 妊娠悪阻に合併した肺血栓塞栓症に対し,妊娠13週で遺伝子組み換え組織プラスミノゲンアクチベーター静注療法を施行し,生児を得た1例
  • ショウレイ ホウコク ニンシン ツワリ ニ ガッペイ シタ ハイ ケッセン ソクセンショウ ニ タイシ,ニンシン 13シュウ デ イデンシ クミカエ ソシキ プラスミノゲンアクチベーター ジョウチュウ リョウホウ オ シコウ シ,セイジ オ エタ 1レイ

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<p>Pulmonary thromboembolism can be a cause of maternal death during pregnancy. We encountered a case of pulmonary thromboembolism caused by hyperemesis gravidarum. The patient was 29-years-old and was multipara. She developed symptoms of morning sickness, 10 weeks into her pregnancy. Thus, intravenous nutrition was provided daily. She started coughing and complaining of shortness of breath at 11 weeks, and subsequent enhanced computed tomography (CT) showed a pulmonary thromboembolism. We treated her with anticoagulant therapy and trans-catheter thrombectomy, but her symptoms and pulmonary hypertension did not improve. We administered recombinant tissue plasminogen activator (rt-PA) to treat the pulmonary thromboembolism at 13 weeks of pregnancy. Her symptoms and pulmonary hypertension improved significantly afterwards. We kept her on heparin for the rest of her gestation period. At 37 weeks and six days of pregnancy, she delivered the child via inducedlabor. The newborn was 3040 g and the Apgar score was nine points at one minute and 10 points at five minutes. There were no complications caused by the use of rt-PA. Both the mother and the newborn had an uneventful postpartum course and they were discharged from the hospital on the 30th postpartum day. In principle, rt-PA can not be used for pregnant women. This is the eighth case of rt-PA administration during pregnancy in Japan. There have been no reports of serious complications related to the use of rt-PA in Japan. We think the use of rt-PA for maternal life saving is permissible. [Adv Obstet Gynecol, 69 (4):386-392, 2017 (H29. 10)]</p>

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