What you need to know on embolism and pregnancy

WHEN I was young, I always wondered why elders would greet a new mother “mwapusukeni” literally meaning “you have survived”.

This did not make sense then until my early days in medical school when I learnt about embryogenesis and physiological changes of pregnancy.
Recently, the country woke up to a rude shock on the passing of a mother (Zambia Daily Mail sub-editor Sithembile Zulu) after giving birth via a ceaserean section.
So, much has been said about the incident and it is regrettable that we could lose a life.
But what is pulmonary embolism and why should a pregnant woman develop it? Are health workers competent to handle such cases?
Pulmonary refers to the lungs. Embolism is the process of blood clotting within the blood vessels. Simply put, pulmonary embolism is a blood clot in the blood vessels located in the lungs. Depending on the site and size, most pulmonary embolism are fatal even in most advanced hospitals on earth.
On clinical grounds, a high index of suspicion is maintained by using what is called the Virchow’s triad.
1. Stasis of blood.
2. Increased tendency of blood to clot (hypercoagubility)
3. Injury to blood vessels.
1. Surgery in the last four weeks
2. Pregnancy
3. Prolonged immobilisation- For example, due to air travel, long distance travel, bed rest etc.
4. Certain cancers
5. Genetic predisposition
6. Use of oral contraceptives
The list goes on.
Pregnancy is a very unique risk for embolism. The pregnancy itself causes blood to have increased tendency to clot (whether this is evolutionary to prevent excessive exsanguination after child birth is still speculative).
Injury to blood vessels during delivery is also unavoidable. In advanced pregnancies, most women tend to become less active (immobile) putting themselves at high risk of embolism.
Surgery also poses a unique risk of embolism.
Doctors are trained to categorise patients into low, moderate and high risk based on what is called the Well’s Score.
This risk stratification is important to guide what tests to do, what treatment to give and how fast should these intervention be carried out.
About 1.3 percent patients considered low risk by Wells Score end up having embolism and only about 40 percent high risk patients have embolism.
We can still appreciate that even this score can not 100 percent predict embolism.
Pulmonary embolism accounts for about 25 percent of all sudden deaths. Meaning a patient can be pretty fine and the next minute they are gone!
Studies have shown that there are 70-80 percent chances of dying from severe pulmonary embolism. Meaning patients who suddenly deteriorates requiring resuscitation are more likely to die than those who are stable whose risk is only 1-2 percent.
This incident should give us an opportunity to work together with the community to raise awareness about maternity issues and what possibly could go wrong.
It should be seen as a window of opportunity to campaign for improved healthcare for all people in Zambian. It is also an opportunity to reaffirm our resolve as a nation to reduce maternal mortality.
Let’s all build a health care system that responds to our needs.

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