Pamela Laquindanum
BSN14B
NCM 106
Case Study
A 33-year-old woman was hospitalized for premature labor at 35 weeks of gestation. Labor was
successfully stopped, and she was discharged home on strict bed rest. She returned three weeks
later in labor. Fetal distress was identified, and an emergency cesarean section resulted in the
delivery of a healthy baby. Two days later, the mother reported “crampy” pain in her right leg
and was prescribed pain medications. Four days after delivery, she developed sudden shortness
of breath and rapid heart rate. A pulmonary embolism was suspected. She was started on the
intravenous anticoagulant heparin and underwent a computed tomography (CT) scan with a
contrast dye injected into her vein to outline the pulmonary arteries. The resulting images
showed a pulmonary embolism, and she was transferred to the intensive care unit. A lower
extremity ultrasound found that the source of the embolism was a venous thrombosis in her
right thigh. Over the next several days, the patient improved, and she was started on an oral
anticoagulation medicine. After a week in the hospital, she returned home, where she recovered
fully.
This patient’s risk factors for pulmonary thromboembolism included immobility, the high levels
of estrogens associated with pregnancy, and the tissue injury associated with surgery. Her first
symptom was subtle and did not immediately suggest venous thrombosis. Once pulmonary
embolism was suspected, prompt lifesaving treatment was begun even before the CT scan
confirmed the diagnosis. This patient was fortunate not to suffer from complications of the
anticoagulant, and the blood clot in her leg was successfully treated. Complications such as
bleeding can occur from anticoagulants. Unresolved blood clots can cause chronic pain and
swelling in the extremity where the thrombosis occurred. In the lungs, unresolved blood clots can
cause increased blood pressure (pulmonary hypertension) and be associated with serious chronic
disease. Happily, this patient fully recovered.
