Multidisciplinary Management of Massive Pulmonary Embolism in Twin Pregnancy Using Percutaneous Thrombectomy: Maternal-Fetal Survival

Massive pulmonary embolism (PE) during pregnancy is a major cause of maternal mortality, with increased risk in twin gestations. Hemodynamic instability in the setting of contraindication to systemic thrombolysis poses a critical therapeutic challenge, requiring a multidisciplinary approach to ensure maternal stabilization and fetal viability. A 32-year-old woman at 29 weeks of twin pregnancy was admitted with bilateral massive PE and obstructive shock. Due to the high obstetric hemorrhagic risk associated with systemic thrombolysis, percutaneous mechanical thrombectomy was performed. The procedure achieved pulmonary reperfusion and reversal of right ventricular dysfunction, allowing maternal stabilization and short-term prolongation of the pregnancy. Subsequently, cesarean delivery was performed due to preterm labor, resulting in two live newborns (Apgar scores of 8/9). The mother had an uneventful recovery without hemorrhagic complications. Massive PE in twin pregnancy can be successfully managed through a multidisciplinary strategy focused on maternal-fetal safety. In this context, percutaneous mechanical thrombectomy represents a safe and effective therapeutic alternative, associated with favorable maternal and perinatal outcomes.