Massive pulmonary embolism during the induction of labor in a middle-aged obese nulliparous woman – a case report

Abstract Massive pregnancy-related pulmonary embolism is a rare but potentially life-threatening event. We report the sudden onset of dyspnea and loss of consciousness in a middle-aged obese nulliparous woman at 39 weeks of gestation during first stage of labor. Shortly after delivery by emergency cesarean section cardiac arrest was recorded. Transesophageal echocardiography during resuscitation showed right ventricular failure leading to the diagnosis of pulmonary embolism. Return of spontaneous circulation was achieved after emergency administration of thrombolysis with alteplase. Uterine hemorrhage, coagulopathy and persistent right ventricular failure resulted in persistent hemodynamic instability leading to supracervical hysterectomy and veno-arterial extracorporal life support. Both mother and baby survived without hypoxic brain injury. Our literature review highlights the crucial importance of individual and interdisciplinary decision-making during emergency situations in pregnant women. Therefore, we conducted a literature review to estimate the extent of evidence on the emergency management of pregnant women with pulmonary embolism. Manuscript