Skip to main content
PMC home page
British Medical Journal logoLink to British Medical Journal
. 1972 Dec 16;4(5841):647–649. doi: 10.1136/bmj.4.5841.647

Treatment of Acute Massive Pulmonary Embolism by Streptokinase during Labour and Delivery

R J C Hall, C Young, G C Sutton, S Cambell
PMCID: PMC1786929  PMID: 4539533

Abstract

A 29-year-old woman sustained an acute massive pulmonary embolism in the 32nd week of pregnancy. Rapid clinical improvement followed the use of streptokinase. Treatment was continued for 41 hours, including labour and the first three hours after delivery. There was slow but severe postpartum haemorrhage. Partial uterine atony occurred, and may have been due, at least in part, to fibrin degradation products arising from thrombolysis. No adverse effects were noted in the baby.

Our experience suggests that streptokinase may be given during labour but that an oxytocic agent may be needed; and that reversal of fibrinolysis before delivery is best achieved by the use of aprotinin (Trasylol) rather than aminocaproic acid.

Full text

PDF
647

Images in this article

647p647-a
on p.647

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Basu H. K. Fibrinolysis and abruptio placentae. J Obstet Gynaecol Br Commonw. 1969 Jun;76(6):481–496. doi: 10.1111/j.1471-0528.1969.tb05868.x. [DOI] [PubMed] [Google Scholar]
  2. Ekelund H., Hedner U., Nilsson I. M. Fibrinolysis in newborns. Acta Paediatr Scand. 1970 Jan;59(1):33–43. doi: 10.1111/j.1651-2227.1970.tb15511.x. [DOI] [PubMed] [Google Scholar]
  3. Evans D. S., Cockett F. B. Diagnosis of deep-vein thrombosis with an ultrasonic Doppler technique. Br Med J. 1969 Jun 28;2(5660):802–804. doi: 10.1136/bmj.2.5660.802. [DOI] [PMC free article] [PubMed] [Google Scholar]
  4. Hirsh J., Hale G. S., McDonald I. G., McCarthy R. A., Pitt A. Streptokinase therapy in acute major pulmonary embolism: effectiveness and problems. Br Med J. 1968 Dec 21;4(5633):729–734. doi: 10.1136/bmj.4.5633.729. [DOI] [PMC free article] [PubMed] [Google Scholar]
  5. Jeffcoate T. N., Tindall V. R. Venous thrombosis and embolism in obstetrics and gynaecology. Aust N Z J Obstet Gynaecol. 1965 Aug;5(3):119–130. doi: 10.1111/j.1479-828x.1965.tb00304.x. [DOI] [PubMed] [Google Scholar]
  6. LANDESMAN R., CAMPBELL W. L., WILSON K. H. Uterine relaxant properties of bradykinin in vitro. Obstet Gynecol. 1963 Jul;22:102–107. [PubMed] [Google Scholar]
  7. Ludwig H. Experimentelle Untersuchungen zum diaplazentaren Ubertritt von Streptokinase. Geburtshilfe Frauenheilkd. 1966 May;26(5):736–739. [PubMed] [Google Scholar]
  8. Ludwig H. Therapeutische Fibrinolyse in der Gravidität. Gynaecologia. 1968 Jun;166(1):20–25. [PubMed] [Google Scholar]
  9. Malofiejew M., Kostrzewska A., Buluk K. The influence of fibrinogen degradation products on the electrobiological activity of the rat heart. Experientia. 1971 Feb 15;27(2):139–140. doi: 10.1007/BF02145855. [DOI] [PubMed] [Google Scholar]
  10. Markarian M., Githens J. H., Jackson J. J., Bannon A. E., Lindley A., Rosenblut E., Martorell R., Lubchenco L. O. Fibrinolytic activity in premature infants. Relationship of the enzyme system to the respiratory distress syndrome. Am J Dis Child. 1967 Mar;113(3):312–321. doi: 10.1001/archpedi.1967.02090180072005. [DOI] [PubMed] [Google Scholar]
  11. Miller G. A., Gibson R. V., Honey M., Sutton G. C. Treatment of pulmonary embolism with streptokinase. A preliminary report. Br Med J. 1969 Mar 29;1(5647):812–815. doi: 10.1136/bmj.1.5647.812. [DOI] [PMC free article] [PubMed] [Google Scholar]
  12. Miller G. A., Sutton G. C., Kerr I. H., Gibson R. V., Honey M. Comparison of streptokinase and heparin in treatment of isolated acute massive pulmonary embolism. Br Med J. 1971 Jun 19;2(5763):681–684. doi: 10.1136/bmj.2.5763.681. [DOI] [PMC free article] [PubMed] [Google Scholar]

Articles from British Medical Journal are provided here courtesy of BMJ Publishing Group

RESOURCES