Abstract

This article examines pulmonary embolism (PE) as a major cause of maternal mortality in the United States. PE occurs when blood clots from other parts of the body block the pulmonary arteries in the lungs. Primarily, PE is caused by DVT and other risk factors such as excess weight, multiple births, and pre-existing illnesses. PE has a broad range of symptoms, including chest pains, coughing, and shortness of breath. Preventing and treating PE involves using anti-coagulants, increased engagement in physical activities, and suitable mechanisms during surgeries and cesarean section.

Pulmonary Embolism as a leading cause of Maternal mortality in the United States

According to World Health Organization (2019), maternal mortality refers to loss of life stemming from pregnancy complications or experienced during childbirth. Within the past two decades, the global maternal mortality rate has reduced from 342 to 295 deaths per 100,000 births, with an annual reduction of over 2.8%. While such progress is remarkable, it falls short of the 6.9% annual reduction target set as per the Sustainable development Goal 3 (WHO, 2019). Although the causes of maternal mortality are relatively the same across all regions, the risk is higher in emerging economies. The most prevalent causes linking to maternal mortality include hemorrhage and pregnancy-associated complications such as eclampsia, thrombolytic embolism, and pulmonary embolism (Lu, 2018, p1237). Presently, pulmonary embolism claims 3% of the total maternal deaths in the U.S. This paper examines pulmonary embolisms as a prominent cause of the persistent maternal mortality in the United States.

According to Konstantinides et al. (2016), pulmonary embolism (PE) occurs when blood clots block pulmonary arteries in the lungs. Typically, the blood clots move from within other parts of the body where blood accumulates and clots due to deep vein thrombosis (DVT). When DVT is left undiagnosed and untreated, the blood clots travel in the bloodstream to the lungs and cause blockage resulting to PE.  Although any person can develop blood clots, pregnant women are highly vulnerable to DVT because their bodies change to prevent excessive bleeding during and after birth. Again, in the late stages of pregnancy, women are merely likely to develop blood clots due to the excess pressure caused by the pregnancy on the blood vessels located in the pelvic region. Moreover, there is a risk of developing blood clots during intrusive processes like surgeries and cesarian sections. Lastly, PE develops due to prolonged bed rest and lack of physical activity during postpartum (Di Nisio et al., 2016, p3060).

Symptoms

The symptoms associated with PE vary according to the affected part of the lung, the size of the clot, and pre-existing respiratory or cardiovascular diseases (Di Nisio et al., 2016, p 3060). Nevertheless, diagnosing PE during pregnancy is problematic since most symptoms overlap or manifest as regular physiological changes that present during pregnancy Righini et al., 2018, p7780. However, vast studies have established the following as the primary symptoms associated with the condition.

• Chest pain

Pregnant women suffering from PE often experience sharp chest pain when they bend, cough, or inhale deeply. According to Simcox et al. (2015), chest pains are among the most significant symptoms associated with PE. In a study consisting of 198 pregnant women diagnosed with PE in the United Kingdom, 52 % percent reported experiencing chest pains (Righini et al., 2017).

• Cough

PE patients cough incessantly and produce blood-stained sputum. In this situation, profound examinations like the CT Scan or MRI are undertaken during diagnosis to establish other conditions like pneumonia that have similar symptoms. However, studies recommend the Duplex Ultrasound test to examine blood flow in the legs before exposing the mother and the unborn baby to radiation which may have adverse side effects on their health (Simcox et al., 2015).

• Shortness of breath

When PE occurs, one or more pulmonary arteries in the lungs block, and thus, the body lacks oxygen. In this situation, PE patients experience sudden and unexplainable shortness of breath that worsens with time. Clinically, this state is referred to as pulmonary infarction (Di Nisio et al., 2016) . Other symptoms associated with PE include leg swelling around the calf due to DVT, excessive sweating, fever, dizziness, discolored skin, and irregular pulse rate.

Risk factors

 Apart from the factors stated above, other aspects increase the risk of PE during and after pregnancy. For instance, pregnant women suffering from cardiovascular diseases and varicose veins are more likely to develop DVT, and consequently, PE. On the other hand, kidney, colon, stomach, ovary, and lung cancers and their treatment processes (especially chemotherapy) increase the risk of DVT and PE (Righini et al., 2018, p782). Again, hereditary illnesses like kidney diseases make it less likely for blood to clot, and hence, pregnant women with a history of such conditions are likely to develop PE.

Complications

Like any illness, PE is life-endangering if not treated promptly. More importantly, extensive studies show that PE causes lung tissue damage, pulmonary hypertension, and damage to other vital body organs. Pulmonary hypertension occurs when the right side of the heart weakens due to the pressure caused by the obstruction of pulmonary arteries in the lungs. Although anticoagulants are some of the most effective therapies against PE, they increase the risk of excessive bleeding (Konstantinides et al., 2016, p980).

Prevention

Since PE emanates from blood clots, most preventive and therapeutic processes aim to prevent DVT. Some of the most effective approaches include proper diagnosis during pregnancy, and careful administration of anticoagulants like Heparin during and after birth. Besides, If patients require prolonged bed rest during and after pregnancy, physical activities like leg stretching, walking, and leg elevation are recommended to increase blood flow to the legs. Moreover, patients should wear compression socks during surgeries and cesarean sections to encourage seamless blood flow to the legs (Konstantinides, et al., 2016, p987). Other measures include drinking a lot of water to avoid dehydration and taking breaks from prolonged sitting, which increases the likelihood of developing DVT. Both independently and collectively, the measures discussed in this paper can help in reducing the incidence and prevalence of PE, and more importantly reducing maternal mortality in the United States.

Reference

Di Nisio, M., van Es, N., & Büller, H. R. (2016). Deep vein thrombosis and pulmonary embolism. The Lancet, 388(10063), 3060-3073.

Konstantinides, S. V., Barco, S., Lankeit, M., & Meyer, G. (2016). Management of pulmonary embolism: an update. Journal of the American College of Cardiology, 67(8), 976-990.

Lu, M. C. (2018). Reducing maternal mortality in the United States. Jama, 320(12), 1237-1238.

Righini, M., Robert-Ebadi, H., Elias, A., Sanchez, O., Le Moigne, E., Schmidt, J., … & Le Gal, G. (2018). Diagnosis of pulmonary embolism during pregnancy: a multicenter prospective management outcome study. Annals of internal medicine, 169(11), 766-773.

Simcox, L. E., Ormesher, L., Tower, C., & Greer, I. A. (2015). Pulmonary thrombo-embolism in pregnancy: diagnosis and management. Breathe (Sheffield, England), 11(4), 282–289. https://doi.org/10.1183/20734735.008815

World Health Organization. (2019). Trends in maternal mortality 2000 to 2017: estimates by WHO, UNICEF, UNFPA, World Bank Group and the United Nations Population Division.