What is pulmonary embolism?
Pulmonary embolism is a disease caused by the blockage of pulmonary artery or its branches by embolism, including thromboembolism, fat embolism, amniotic fluid embolism, air embolism, etc., among which the most common is thromboembolism.
What are the symptoms of pulmonary embolism?
Sudden onset, mostly sudden unexplained cardiovascular deficiency, cold sweat, pale face, 82% of sudden dyspnea, 49% of chest pain, 20% of cough, 14% of syncope, 7% of hemoptysis.
Symptoms of cerebral hypoxia: extreme anxiety, fear, apathy, lethargy, nausea, convulsions and coma in patients.
Acute pain: chest pain, shoulder pain, neck pain, anterior cardiac area and epigastric pain.
Symptoms of acute right heart failure and even sudden death may occur if suffering from a large arterial embolism.
What are the high risk factors for pulmonary embolism during pregnancy?
Pulmonary embolism is a serious complication of venous thrombosis. The high-risk factors for inducing pulmonary embolism during pregnancy mainly include the following.
Pregnancy itself is a high-risk factor for pulmonary embolism. The risk of both arterial and venous embolism increases during pregnancy, but venous embolism predominates, accounting for approximately 80% of cases. In addition to the physiological factor that the blood of pregnant women is in a hypercoagulable state, the presence of various factors such as increased venous blood volume during pregnancy, slow venous blood flow, compression of the pelvic veins by the pregnant uterus, and reduced activity of pregnant women increase the risk of pulmonary embolism during pregnancy by 7 to 10 times compared to non-pregnant women of the same age, with an incidence rate of 0.5‰ to 1.2‰.
Acquired embolism
Acquired embolism includes autoimmune diseases such as antiphospholipid syndrome, systemic lupus erythematosus, hematologic diseases such as erythrocytosis and thrombocytosis, endocrine diseases such as diabetes mellitus and Cushing’s syndrome, as well as nephrotic syndrome, liver disease and malignancy. Pregnant women with antiphospholipid syndrome and systemic lupus erythematosus are prone to recurrent miscarriages, and once a successful pregnancy is achieved, they also become at high risk for embolic disease during pregnancy.
Genetic predisposition to embolic disorders
Hereditary disorders have significant racial differences and are very rare in the Chinese population. Inherited defects in protein C and protein S are important risk factors for venous thrombosis in the Chinese population. These genetic alterations cause enhanced coagulation and fibrinolysis.
Other factors
History of venous thrombosis or pulmonary embolism:It is the most important risk factor for pulmonary embolism in pregnancy, and the risk of developing it increases significantly in the second pregnancy. About 1/3 of pregnant women with venous embolism in pregnancy have a previous history of embolism.
Obesity:The risk of VTE increases 2-3 times when the body mass index is >30, and the risk is higher in severe obesity (body mass index >40).
Braking or sedentary:One study found a 2-fold increased risk of venous embolism chills in the weeks following a long trip (more than 4 h of continuous transportation).
Excessive meat intake: Excessive intake of red meat or processed meat, insufficient intake of fruits and vegetables, etc.
These factors, especially the presence of hereditary or acquired thrombophilia, significantly increase the risk of developing VITE during pregnancy, and about 50% of patients with thromboembolism in pregnancy have hereditary or acquired thrombophilia.
How to prevent pulmonary embolism during pregnancy?
Generally, through careful clinical examination, early detection of deep vein thrombosis in the lower extremities can prevent the occurrence of pulmonary embolism in 80% of patients, and the following measures can be taken to prevent venous thrombosis.
1.Cesarean section or difficult delivery should be operated gently and meticulously to reduce tissue damage, especially pay attention to avoid damage to blood vessels and induce thrombosis. During delivery, dehydration should be corrected in time to maintain water and electrolyte balance and prevent blood coagulation from increasing.
2.After delivery and surgery, encourage the patient to turn over and flex and stretch the lower limbs as much as possible, and guide the patient to get out of bed early to promote blood reflux and enhance blood circulation.
3.Apply prophylactic anticoagulation therapy when necessary.
At present, with the change of everyone’s living habits, the proportion of senior pregnant women is gradually climbing, and the incidence of pregnancy complications is also rising. Pulmonary embolism during pregnancy is slowly eroding and spreading to the whole world, so we should not ignore this terrible disease.