• Talya Shaulov, Michèle David, Marieve Pellerin, and Francine Morin.
• Department of Obstetrics and Gynaecology, Centre hospitalier universitaire Sainte-Justine, Montreal QC.
• J Obstet Gynaecol Can. 2014 Jun 1; 36 (6): 498-501.

BackgroundCardiac arrest following a massive pulmonary embolism in pregnancy or the puerperium is a rare and catastrophic event.CaseWe describe a case of massive pulmonary embolism with cardiac arrest in a 36-year-old patient, presenting 48 hours postpartum. She was treated with thrombolytic therapy and suffered a massive hemorrhage thereafter, which was compounded by disseminated intravascular coagulation. Following an emergency hysterectomy and massive blood-product transfusion, she survived with no neurological sequelae. The medical team present had participated in two simulation sessions with similar scenarios in the weeks before the event.ConclusionTo our knowledge, this is only the fifth case reported in the literature on thrombolytic therapy in the postpartum period, and of these has the most severe hemorrhagic complication. An effective multidisciplinary approach to such a complex situation can be acquired through simulation-based training.

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