Dual clinical dilemmas in late pregnancy: A multidisciplinary conservative approach to high-risk pulmonary embolism with persistent category III fetal status

Abstract

Pregnancy increases the risk of venous thromboembolism, and pulmonary embolism (PE) remains a leading cause of maternal morbidity and mortality. Diagnosis is challenging due to symptom overlap with normal pregnancy, and management is complex in severe cases without hemodynamic instability. A 32-year-old woman at 32 weeks’ gestation presented with dyspnea, chest pain, and hypoxemia. CT pulmonary angiography confirmed a saddle PE with right ventricular strain. Despite high oxygen requirements, she remained hemodynamically stable. She was managed in the intensive care unit with therapeutic anticoagulation and high-flow oxygen, while thrombolysis was deferred due to bleeding risk. Fetal monitoring showed intermittent nonreassuring findings likely related to maternal hypoxia. Following multidisciplinary discussion, conservative management was continued. The patient improved clinically, was discharged on low-molecular-weight heparin, and later delivered at 39 weeks with good maternal and neonatal outcomes.