A Case Who Developed Loss of Consciousness and Severe Bradycardia during Placental Abruption in Cesarean Section, and Was Diagnosed as Pulmonary Thromboembolism

Abstract

A 31-year-old parturient with twins was scheduled for cesarean section under spinal anesthesia. The preoperative D-dimer level was 3.7μg/mL. During placental abruption, the mother suddenly lost consciousness, had convulsions, and showed severe bradycardia. Chest compressions were started simultaneously with induction of general anesthesia, and her hemodynamics soon improved. After surgery, a contrast-enhanced CT scan showed thrombus in the peripheral pulmonary arteries on both the right and left sides. The normal range of D-dimer values during pregnancy has not been established. In this case, we did not perform any additional tests because we considered the value to be the upper limit of normal range. It is recommended that the cutoff value for additional examinations be determined at each institution, so our institution set the upper limit at 3μg/mL based on this case. In cesarean sections, careful perinatal management should be performed, always considering the possibility of pulmonary thromboembolism.