1.A Case of Deep Venous Thrombosis and Pulmonary Thrombosis during Week 29 of Pregnancy
Sanae HATTORI ; Maiko ICHIKAWA ; Shiori OKIKURA ; Haruka MANAYAMA ; Kaori TAKAGI ; Yasuko NISHIDA ; Yukiko NUSHI ; Reiko NAKAMURA ; Tamami ODAI ; Seiichi ENDO ; Masae SAKAMOTO ; Koji SHIMABUKURO
Journal of the Japanese Association of Rural Medicine 2016;65(4):857-861
A major cause of pulmonary thromboembolism (PTE) is deep venous thrombosis (DVT). We report here a case of DVT in a 31-year-old woman during week 29 of her second pregnancy. At week 29, the patient noticed swelling of the left leg and pain in the groin after sitting. At almost week 30, walking became difficult due to pain and she was referred to hospital. Computed tomography (CT) revealed a thrombus from the left common iliac vein to the femoral vein and multiple thrombi in the right pulmonary artery. Blood testing showed elevated D-dimer (3.4μg/ml). Continuous intravenous unfractionated heparin was administered, and the dose was increased due to decreased activated partial thromboplastin time control. Despite conservative therapy for DVT, the thrombi showed no change since admission. At almost week 37, a temporary inferior vena cava filter (t-IVCF) was placed to prevent pulmonary thromboembolism, and she had an uneventful delivery of a baby by Caesarean section. Warfarin was administered postpartum. The t-IVCF was removed 4 days after delivery, and the patient was discharged 10 days after delivery. Within the field of obstetrics, the need for IVCF insertion should be considered on an individual case basis and should not be viewed as a standard option.
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