Massive pulmonary embolism after cesarean section in a pregnant with occult pneumonia after COVID-19 infection: A case report.

RATIONALE: Pregnant and postpartum women have a hypercoagulable state, and COVID-19 infection further heightens the risk of venous thromboembolism, with pulmonary embolism (PE) in COVID-19-infected pregnant women being a global concern.

PATIENT CONCERNS: A 47-year-old pregnant woman with a history of 3 vaginal deliveries and 1 cesarean section, who had a neo-coronavirus infection 29 days ago with rapid symptom resolution, developed asymptomatic massive PE within 24 hours after cesarean section at 38+ weeks of gestation.

DIAGNOSES: Massive PE was diagnosed by computed tomography pulmonary angiography, which showed thromboembolism in multiple parts of the pulmonary arteries, along with pleural effusion and lung inflammation. Cardiac ultrasound revealed mildly elevated pulmonary artery systolic pressure and mild mitral and tricuspid regurgitation.

INTERVENTIONS: Anticoagulation therapy was initially with enoxaparin sodium injection, and the dosage was adjusted. Intravenous anti-infection therapy was also given. After discharge, the patient was switched to rivaroxaban. Compression stockings were used for venous thromboembolism prevention.

OUTCOMES: After 5 months of anticoagulation therapy, the computed tomography pulmonary angiography of the pulmonary artery was completely normalized, but a small amount of interstitial lung lesions still persisted.

LESSONS: Pregnant women infected with the new coronavirus need close attention during pregnancy and puerperium, especially those with thrombosis risk factors who should receive early anticoagulation. There are many aspects worthy of further exploration, such as the necessity of early pulmonary computed tomography scans and appropriate anticoagulant dosage in pregnant women with COVID-19 infection.