Pulmonary thromboembolism and its complications in a patient in labour

Venous thromboembolic event in pregnancy is a rare but dreaded complication. When it occurs in labour, it presents with sudden severe fetal distress and maternal haemodynamic compromise. We present to you a case where in patient was taken up for emergency caesarean section for severe fetal distress. Intraoperative ECG showed right heart strain. Hence, an immediate bedside echocardiography was done in medical intensive care unit and it picked up a swirling thrombus in right atrium which immediately got dislodged to pulmonary vessels. Postcaesarean, we faced challenge of controlling active bleeding from atonic uterus with non-surgical techniques (Bakri balloon tamponade and uterine artery embolisation) before considering anticoagulation therapy for pulmonary embolism. The patient recovered well after anticoagulation treatment.