Pulmonary embolism complicating pregnancy, labor, and the puerperium

Abstract

Due to the infrequency of pulmonary embolism complicating pregnancy, labor, and the puerperium, it is impossible to formulate any definite conclusions from this small series. But, from this study of thirty-two cases which occurred in 31,716 pregnant patients, we may summarize as follows: 1.1. The incidence of pulmonary embolism was approximately 0.1 per cent.2.2. The incidence of pulmonary embolism was three times greater in operative than in normal deliveries.3.3. The incidence of pulmonary embolism was 1.5 per cent in all cases of cesarean section, and 2 per cent in all cases of placenta previa.4.4. Secondary embolism was uncommon, occurring only twice in the thirty-two cases; i. e., in about 6 per cent of the cases, and following the first embolus by at least two weeks.5.5. The onset of the condition in the twenty-four patients delivered was immediate in six cases, in the first twenty-four hours in two cases, from the third to ninth day in seven cases, from ninth to twentieth day in seven cases, and after the twentieth day in two cases.6.6. In the entire series of thirty-two cases the mortality was 65 per cent and in the twenty-four patients delivered the mortality was 66.6 per cent.7.7. Of the cases which terminated fatally 70 per cent died within an hour from the onset of symptoms, and 90 per cent within twenty-four hours.8.8. Treatment.—The usual sedative, supportive, and stimulative measures after the onset of the condition, but prophylactic in the direction of overcoming circulatory stasis, the development of greater aseptic technic, transfusions for anemia before the onset of labor, and in decreasing blood loss at the time of delivery.