Martillotti G, et al. – A systematic review is carried out to systematically review the proof to guide massive pulmonary embolism management. Published cases of thrombolysis for massive pulmonary embolism (PE) amid pregnancy and the postpartum period propose a high maternal and fetal survival (94% and 88%). In the postpartum period, given the high risk of major bleeding with thrombolysis in the postpartum period, other therapeutic options (catheter (or surgical) thrombectomy, ECMO) may be considered if available.

Methods

• In this study, they looked Pubmed, Embase, conference proceedings and the RIETE registry for published cases of severe (submassive/massive) PE treated with thrombolysis, percutaneous or surgical thrombectomy and/or with ECMO, occurring amid pregnancy or within 6 weeks of delivery.
• Main outcomes were maternal survival and major bleeding, premature delivery, fetal survival and bleeding.

Results

• Total 127 cases of severe PE (at least 83% massive, 23% with cardiac arrest) treated with at least one modality were found in this study.
• Among 83 women with thrombolysis, survival was 94% (95%CI 86–98).
• The risk of major bleeding was 17.5% amid pregnancy and 53.9% in the postpartum period, mainly because of severe postpartum hemorrhages.
• Fetal deaths possibly related to PE or its treatment occurred in 12.0% of cases treated amid pregnancy.
• Among 36 women with surgical thrombectomy, maternal survival and risk of major bleeding were 86.1% (95%CI 71–95) and 20.0%, with fetal deaths possibly identified with surgery in 20.0%.
• About 50% of severe postpartum PE occurred within 24h of delivery.