Abstract:

Objective

A case of postpartum hemorrhage complicated with pulmonary hemorrhage was reported. The relevant clinical characteristics were analyzed based on a literature review to improve clinicians′ understanding of maternal pulmonary hemorrhage.

Methods

A patient with postpartum hemorrhage complicated with pulmonary hemorrhage admitted to the Third Affiliated Hospital of Guangzhou Medical University was retrospectively analyzed and the clinical data of 21 case reports related to perinatal pulmonary hemorrhage were retrieved through the database.

Results

The etiology，clinical manifestations，and diagnosis and treatment process of the 22 patients were different. Among the 22 patients， 12 patients（54.5%） developed during pregnancy， and 10 patients （45.5%） developed during puerperium. 17 cases（77.3%） were caused by immune factors， with systemic lupus erythematosus accounting for the majority.5 cases （22.7%） were caused by non-immune factors， with coagulation dysfunction most common. The first symptom was dyspnea in 18 cases （81.8%）， hemoptysis in 10 cases （45.5%）， fever in 6 cases（27.3%）， and cough in 7 cases （31.8%）.In terms of treatment，19 patients received hormone therapy，9 patients received plasma exchange therapy， and 3 patients received ECMO therapy， with good outcomes.Pregnancy outcomes included maternal death in 5 cases （22.7%）， fetal loss in 3 cases （13.6%），continued pregnancy in 2 cases （9.2%）， and the remaining 12 cases （54.5%） had good maternal and infant outcomes.This case and the 2 cases reported in the literature were pulmonary hemorrhages related to coagulation dysfunction. All three patients developed during the puerperium and had disseminated intravascular coagulation. Clinical manifestations included dyspnea， decreased blood oxygen saturation，and bloody secretions in the trachea. Based on treating the primary disease， some patients received supportive treatment measures such as plasma exchange and ECMO， and the outcome was good.

Conclusions

Pregnant women with pulmonary hemorrhage are in critical condition， with a high mortality rate and atypical clinical manifestations. It is necessary to improve obstetricians′ understanding and learning of this disease， and at the same time strengthen multidisciplinary cooperation.

Key words: Postpartum hemorrhage, Lung diseases, Hemorrhage, Pregnancy, Extracorporeal membrane oxygenation