Intensive Care Management of Peripartum Pulmonary Embolism

Abstract

The pulmonary circulation differs dramatically from the systemic circulation in its biophysical and hemodynamic properties, structural organization, and physiology. the pulmonary circulation is designed to maximize oxygen uptake in the blood that will ultimately nourish the rest of the body. During pregnancy the plasma volume increases by 50% and the red blood cell volume increases only by 20–30% with increased liver production of coagulation factors, mainly fibrinogen and factor VIII. Pregnancy and the postpartum period are marked by the presence of all three components of Virchow's triad: venous stasis, endothelial injury, and a hypercoagulable state. All features likely contribute to the increased risk of VTE in pregnancy. Pregnancy and the puerperium (postpartum period) are well established risk factors for venous thromboembolism (VTE), which occurs with a prevalence of 1 in 1600. The overlap with symptoms of pregnancy may impair clinical suspicion making diagnosis of VTE more challenging. PE is the seventh leading cause of maternal mortality, responsible for 9 percent of maternal deaths.