Thrombotic pulmonary embolism of inferior vena cava during caesarean section: A case report and review of the literature

Table 1 Routine transthoracic echocardiography monitoring

Gestation (W)	LAD (mm)	LVDD (mm)	RA (mm)	LVEF (%)	LVFS (%)	MVA (cm2)	MR (cm2)	AR (cm2)	TR (cm2)	PASP (mmHg)	Cardiac rhythm
28 +	63	58	56 × 41	58	31	2.3	23.3	2.7	5.1	63	Normal
29 +	64	61	54 × 40	67	38	2.3	17.6	3.6	3.5	46	AF
30 +	65	59	51 × 43	66	37	2.3	18.4	3.6	2.1	37	AF
33 +	65	54	60 × 48	52	27	2.3	26.7	4.0	14.5	75	AF
Preoperative day 1	63	54	59 × 51	52	27	2.3	24.6	4.2	14.3	53	AF
Postoperative day 1	62	52	58 × 46	45	22	2.3	19.5	7.3	8.1	54	AF

RA: RATD × RALD. LAD: Left atrial diameter; LVDD: Left ventricular end diastolic diameter; RA: Right atrial; RATD: Right atrial transverse diameter; RALD: Right atrial longitudinal diameter; LVEF: Left ventricular ejection fraction; MAV: Mitral valve area; MR: Mitral regurgitation; AR: Aortic regurgitation; TR: Tricuspid regurgitation; PASP: Pulmonary arterial systolic pressure; AF: Atrial fibrillation.

Table 2 The timeline of thrombosis development and thrombotic pulmonary embolism

Check times	Patient states	End of the thrombus reaches	Thrombus size (long × thick, mm)	Tr (cm2)	Pasp (mmHg)	SaO2 (%)	Act (s)	Lmwh dose (mL)
10:40 am	20 min before CS	-	-	8.5	45	99	-	-
11:23 am	After removed fetus	IVC	81 × 11	10.8	56	96	-	-
11:26 am	Suturing the uterus	IVC entrance	86 × 12	13.7	56	96	-	-
11:36 am	After uterine suture	RA	100 × 13	10.7	54	98	-	-
11:41 am	Ligation uterine arteries	Tricuspid valve	155 × 13	6.8	64	99	-	-
11:55 am	Suturing the skin	Fall off to RH	55 × 28	5.0	69	98	114	140, iv
12:06 am	Informed consent	Fall off to LPA, RPA	Undeterminable	12.2	93	96	380	-
12:10 am	Hysterectomy	Located at LPA, RPA	Undeterminable	11.0	90	97	429	60, iv
1:50 pm	Closed abdomen	MV and LAA appeared thrombus	17 × 15 in LAA, others undeterminable	11.6	71	98	384	50, iv
Postoperative day 1	In ICU	Located at LPA, RPA, LAA	17 × 15 in LAA, Others undeterminable	8.1	54	100	-	30/q12h, HI

TR: Tricuspid regurgitation; PASP: Pulmonary arterial systolic pressure; SaO2: Oxygen saturation by pulse oximetry; ACT: Activated coagulation time; LMWH: Low molecular weight heparin; ICU: Intensive care unit; IVC: Inferior vena cava; RA: Right atrial; RH: Right heart; LPA: Left pulmonary artery; RPA: Right pulmonary artery; MV: Mitral valve; LAA: Left atrial appendage; iv: Intravenous; HI: Hypodermic injection.