Jacek Lisawa | PubMed Health

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[Fibrinolytic therapy of pulmonary embolism in pregnant women].

Fibrinolytic therapy has an established position in the treatment of pulmonary embolism. Its use has proven to decrease patients' mortality. However, in pregnant women such treatment is considered risky, due to possible fatal haemorrhagic events. In spite of such disadvantages, fibrinolytic therapy has been used in pregnant women with good results: from definite improvement of clinical status to complete recovery. No severe haemorrhagic events were observed in these cases and overall mortality was significantly decreased. These findings show that the use of fibrinolytic therapy in emergency situations is an efficient and safe method, when applied in accordance with standard procedures. In this publication we present the general review of current knowledge regarding the use of fibrinolytic therapy in pregnant women.

Anticoagulants↗

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[External cephalic version at term].

About 3 - 4 % of all pregnancies reach term with a foetus in the breech presentation. Because of higher risk of complications for mother and foetus during the vaginal breech birth, only 50% of patients try to deliver vaginally - at the end 40 - 70% of labours are finished by caesarean section. In other cases planned caesarean sections are performed, and finally 10 - 20% of patients with breech presentation at term deliver vaginally. Prenatal mortality and serious complications after breech vaginal birth are 5% and after planned caesarean section 1.6%. This is the reason why the caesarean section is chosen as a final way of delivery with breech presentation. At present, after a period of increasing percentage of caesarean section one can observe a tendency to decrease this number. One of the procedures performed to decrease the number of complications and cost of perinatal management is external cephalic version (ECV). An indication to ECV is breech presentation at term, while there is no contraindication to ECV. Multiple pregnancy, significant third - trimester bleeding, uteroplacental insufficiency, IUGR, oligohydramnion, PROM, PIH, nonreassuring foetal monitoring patterns and all contraindications to vaginal birth are concerned to execute ECV. The real number of patients with breech presentation at term, after ECV, is according to the literature about 1 - 1.5%. The risk of serious complications during ECV, which are the indications for urgent caesarean section, is 1 - 3%. The risk of intrauterine death of foetus after ECV is about 0.0001%. According to the literature it appears that ECV at term seems to be useful and it is safe both for the mother and the foetus and helps to avoid a significant number of caesarean sections.

Breech Presentation↗