Book of Medical Disorders in Pregnancy - Tintash

When the embolus is small and non fatal,
oxygen and a potent analgesic for relief
of pain should be given. When' pyrexia
develops, as it often does, then
indiscriminate use of antibiotics is not
indicated: as the pyrexia will settle on its
own accord, when the extravasated
blood is absorbed. If a pleural effusion
has developed, it will resolve
spontaneously in the course of a few
weeks. Once the acute phase is under
control, and pain permits active
physiotherapy, ambulation should be
started. These measures should be
started without further delay and
continued till the patient is completely
recovered.
Deep venous thrombosis:
Some prefer to change heparin with one
of the oral anticoagulants after 24 to 48
hours especially if treatment is to be
continued for several weeks.
Embolectomy:
When the patient shows no response to
resuscitative measures death occurs
within 2 hours in two third of the fatal
cases, and leaves no time for any form of
surgery to be performed. The results of
surgery even in the specialized centre are
not good. Even successful embolectomy
is accompanied with a recurrence of
embolism in great majority of cases. The
merit of this operation therefore must be
weighed against its benefits and success
rate. However where facilities and
expertise for such measures are
present/patient should be given the
benefit of this heroic therapy. Inferior
Vena Cava may be tied just beyond its
origin. This is performed by an
extraperitoneal approach to the vessels
through a right paramedian muscle-
145
splitting incision. Some prefer partial
occlusion of the inferior vena cava and
ovarian veins with serrated teflon clips
in order to lessen the risk of severe o
edema. Anti-coagulant therapy is
necessary even when ligation is
performed. Indications for surgery are,
repeated emboli occurring in a woman
for whom anti-coagulant therapy is
contra indicated i.e. infective hepatitis,
peptic ulcer or hamate. Mesi in the past.
Thrombolytic therapy:
This form of treatment is as yet in the
experimental stage. Powerful fibrinolytic
enzyme can cause dissolution of recently
formed thrombo plasmin or activators of
plasminogen. Streptokinase and
urokinase may be used for this purpose.
Specially trained physician should only
undertake the type of therapy.
Amniotic fluid embolism:
It is very difficult to assess the exact
incidence of this complication, since the
diagnosis of this complication is often
made by postmortem examination of the
lungs or right ventricular blood. It is also
possible that some patients recover from
minor episodes, and are never diagnosed.
Commonly used drugs for
thromboembolic disease: and their
mechanism of action: antiplatelet
drugs:
Example: Aspirin, Prevents platelet
aggregation /adhesion, Clinical use
prevents arterial thrombus: Myocardial
infraction (MI), stroke, heart valve replacement
and shunts and other antiplatelet
drugs are dipyridamole,
sulfinpyrazone and Ticlopidine.