Shija performs first IVC filter placement on pregnant patient
Source: Chronicle News Service
Imphal, March 04 2023:
Shija Hospitals reportedly performed its first IVC filter placement on a pregnant patient.
According to a release, a 32-year-old woman with 37 weeks of pregnancy and diagnosed with right leg DVT (deep vein thrombosis) was referred to the hospital.
The diagnosis of right leg DVT was made in August 2022 and heparin (a blood thinner) initiated for the treatment of DVT.
However due to falling platelet count, it was stopped by the treating doctor.
Since the thrombus persisted, she was referred to Shija Hospitals for further management.
DVT is a condition in which a clot forms in the deep veins of the body, most commonly in the leg veins.
The blood clot has the potential to break free and travel in the bloodstream and get lodged in the vessels of the lung, a condition known as Venous Thromboembolism (VTE), in which case it becomes a life threatening situation.
During the initial workup of the referred case, a clinical diagnosis of APLA (anti phospholipid antibody syndrome) was made.
An expert opinion of a haematologist was also sought to confirm the diagnosis.
APLA is an autoimmune disease in which the body produces antibodies which can form clots in the vessels.
A multidisciplinary approach was taken towards the management of the case including the physician, Dr Chakshu, anaesthesiologists Dr Kennedy and Dr Kajal, interventional radiologist Dr Gautam Thangjam and gynaecologist Dr Subodha.
Heparin was restarted along with steroid and other supportive medications.
A pre-anaesthetic check-up was done and a planned elective caesarean section (CS) was made.
After weighing the risks/benefits of the case, the anaesthesia team and the interventional radiologist decided to get an IVC filter placed preoperatively due to IVC thrombosis on Doppler (although confirmation couldn't be done), risk of pulmonary embolism was high in view of persistent high D-Dimer, patient party's wish for complete safe-proof approach to CS and relative contraindication of anticoagulant (low platelet).
The alternative plan of general anaesthesia for the CS was also discussed with the family, the release further explained.
Inferior Vena Cava (IVC) filter is a metal device that is placed in the IVC which helps to trap blood clots and hence prevents VTE.
This management option becomes important in patients who have risk of low platelet count and established case of DVT in which case compression stockings are contraindicated.
However, since it is a procedure requiring radiological assistance, there is risk of radiation exposure to the fetus in utero, it continued.
"In the state's context, this is the first case of an IVC filter placement on a pregnant patient.
Limiting fluoroscopic exposure to seconds, the procedure was done successfully by Dr Gautam Thangjam," said the hospital.
After four days of the IVC filter placement, the patient was taken up for caesarean section on February 21, 2023.Since the platelet count was 60k, the case was done under general anaesthesia.
The procedure was uneventful and a live, healthy baby was delivered by the gynaecologist.
The patient was restarted on heparin postoperatively and was discharged with an advice for follow up physician, gynaecologist and haematologist, it added.
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