DOI: https://doi.org/10.36347/sasjs.2025.v11i11.004

Pages: 1055-1059

Massive pulmonary embolism (PE) in the immediate postpartum period is rare but life-threatening We report a 31-year-old primigravida with gestational diabetes who developed sudden severe shortness of breath, dizziness, and hypotension on postoperative day one following an elective lower segment caesarean section. Initial evaluation revealed a saddle PE with large thrombi in the right atrium and inferior vena cava. The patient was first referred to a private centre but surgical intervention was deferred due to high operative risk. She was transferred to a tertiary government hospital and underwent urgent surgical pulmonary embolectomy and RA/IVC thrombectomy on cardiopulmonary bypass. Postoperatively, she was successfully extubated, anticoagulated with warfarin, and discharged in stable condition. This case highlights the importance of early recognition, rapid transfer to specialised centres, multidisciplinary management, and prompt surgical intervention in postpartum patients with massive PE and intracardiac thrombi. Postoperative anticoagulation and imaging surveillance remain essential to prevent recurrence