Abstract
Venous thromboembolism (VTE) is a leading cause of maternal morbidity and mortality, although it is rarely reported in the very early stages of pregnancy or in the setting of following medical abortion.
We present the case of a woman in her late 20s from West Africa who developed bilateral pulmonary embolism a few hours after taking mifepristone as part of a medical abortion protocol at approximately 4–5 weeks of gestation. The patient’s medical history was unremarkable, with no personal or family history of VTE and no chronic medical conditions. She had two previous uneventful pregnancies, was normoweight and a non-smoker. She did not experience hyperemesis gravidarum, had not undertaken long-distance travel, and had not been immobilized during the preceding six months. Furthermore, she had not undergone assisted reproductive technologies and was not receiving chronic medications, including oral contraceptives.
Pulmonary embolism was confirmed by contrast-enhanced chest computed tomography, which revealed bilateral segmental emboli in the lower lobes with associated parenchymal consolidations suggestive of infarct-type lesions.
She was treated with low molecular weight heparin followed by edoxaban, resulting in rapid and complete clinical recovery.
Although pregnancy itself represents a well-established hypercoagulable state and remains the most likely predisposing factor for VTE in this case, the occurrence of pulmonary embolism in close temporal proximity to mifepristone administration is noteworthy. This observation should be interpreted with caution and does not establish a causal relationship. Rather, it underscores the need for heightened clinical awareness of VTE even in very early pregnancy and highlights the importance of further research and pharmacovigilance to better characterize thromboembolic risk in this clinical context.
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