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Massive pulmonary embolism postpartum — SCE Acute Medicine MCQ

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HardRespiratory medicineMassive pulmonary embolism postpartumSCE Acute Medicine

A 35-year-old woman has sudden severe dyspnoea one day after caesarean section. BP is 74/42 mmHg, SpO2 82% on high-flow oxygen and pulse is 142/min. Bedside echocardiography shows a dilated right ventricle with septal flattening. There is no major bleeding. What is the most appropriate next step in management?

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Correct answer: C — Give systemic thrombolysis after senior multidisciplinary discussion because PE is causing shock

Massive PE with shock is immediately life-threatening, and bedside echo evidence of RV strain can support emergency reperfusion when definitive imaging would delay treatment. Postpartum bleeding risk is important, so senior multidisciplinary decision-making is needed, but shock may justify thrombolysis. D-dimer and prophylactic anticoagulation are inadequate in this scenario.

Reference: NICE NG158; BTS PE Guideline