Use of a temporary vena cava filter in a woman with septic abortion and inferior vena cava thrombosis. A case report

BACKGROUND: Ovarian vein and inferior vena cava (IVC) thrombosis are rare but life-threatening complications of severe obstetric infections. IVC filters have been used to reduce the risk of pulmonary embolus in patients who have recurrent thrombotic and embolic events or underlying risk factors. More recently, retrievable IVC filters have been used in patients in whom the risk is transient. CASE: At 18 weeks' gestation a multigravida with a fetus with anencephaly became septic after Laminaria placement and rupture of the membranes. She developed ovarian vein and IVC thrombosis and was treated successfully with a retrievable IVC filter, anticoagulation and antibiotics. The filter was removed after 9 days. CONCLUSION: In young patients at transient risk for emboli and requiring placement of an IVC filter, a retrievable filter should be considered to reduce the long-term risks of an indwelling filter.     

Use of a retrievable inferior vena cava filter in term pregnancy: Case report and review of literature

Venous thromboembolism is a significant cause of morbidity and mortality in obstetrics. Management with anticoagulation can be problematic, especially peripartum. We report the successful placement and retrieval of an inferior vena cava filter as prophylaxis for peripartum pulmonary embolism in a woman with a large, proximal, deep venous thrombosis at term.     

Enoxaparin for postpartum ovarian vein thrombosis. A case report

BACKGROUND: Intravenous heparin is a recognized treatment for ovarian vein thrombosis. Although an effective, less cumbersome alternative exists with lowmolecular-weight heparins, the literature does not contain reports of their use for this condition. We report a case of postpartum ovarian vein thrombosis managed with enoxaparin. CASE: A 29-year-old woman, gravida 1, para 1001, was readmitted with postpartum endomyometritis. After 5 days of appropriate antibiotics, computed tomography of the abdomen/pelvis demonstrated a right ovarian vein thrombus. Enoxaparin was initiated, resulting in a rapid clinical improvement, and hospital discharge was achieved within 36 hours. CONCLUSION: Enoxaparin treatment for avarian vein thrombosis is an alternative to intravenous heparin that may permit a shorter hospital stay without the need for coagulation profile monitoring.     

Thrombophlebitis of the right ovarian vein with thrombosis of the inferior vena cava in the post-partum

A 31-year-old woman presented, in post-partum day two, an abdominal pain associated with fever. Appendicitis was suspected on clinical and radiological elements, and a laparoscopy carried out. This found a normal appendix but a right ovarian vein thrombophlebitis. A second injected scan confirmed the diagnosis, the right renal vein and the inferior vena cava being affected. We started an anticoagulation treatment associated with a large antibiotherapy. The patient was transferred to the intensive care unit to prevent the risk of pulmonary embolism.     

Use of inferior vena cava filters in thromboembolic disease during labor: case report with a literature review.

Thromboembolic diseases during pregnancy are usually managed by conventional anticoagulation and patients are at high risk of pulmonary embolism. Inferior Vena Cava (IVC) filters can be used in cases of documented pulmonary embolism (PE) where anticoagulation is contraindicated or has failed. In our case the patient was diagnosed as having a deep vein thrombosis (DVT) and was started on anticoagulant therapy. Twenty four hours afterwards she went into labor and an IVC filter was inserted due to the risk of pulmonary embolism. She was managed successfully during labor and postpartum period. This shows that IVC filters can be used during labor to try and prevent pulmonary emboli.     

Ovarian cyst formation and congenital absence of the inferior vena cava: case report

Congenital absence of the inferior vena cava (IVC) is a rare condition that presents clinically as recurrent venous thromboses and leg ulcers. We report an association with painful ovarian cysts in a 25 year old woman. The possible pathophysiology and unique management issues posed by this case are presented.     

The inferior vena cava diameter is a useful ultrasound finding for predicting postpartum blood loss

Purpose: To assess whether the ultrasonographic measurement of the inferior vena cava (IVC) diameter in postpartum women is a useful parameter in evaluating the actual blood loss during delivery due to massive postpartum hemorrhage.

Materials and methods: In postpartum women with blood loss ≥500?g, abdominal ultrasonography was performed 1 hour after delivery. The IVC diameter was measured during inspiration (IVCi) and expiration (IVCe). The maternal heart rate, blood pressure, and shock index (heart rate/systolic blood pressure) were also measured. The predictive value of these parameters for severe anemia (hemoglobin <7.0?g/dL) a day after delivery was evaluated via receiver operating characteristic (ROC) analyses.

Results: Seven patients with severe anemia and 77 controls were included in the analysis. The area under the curve (AUC) for IVCi (0.905) and IVCe (0.926) was higher than that for the shock index (0.890), heart rate (0.874), or systolic blood pressure (0.752). Among the examined parameters, the best sensitivity was achieved by IVCe and systolic blood pressure (71.4%).

Conclusions: The ultrasonographic measurement of the IVC diameter was found to be the most useful parameter in evaluating the actual maternal blood loss after delivery.     

Use of inferior vena cava filters in thromboembolic disease during labor: Case report with a literature review

Thromboembolic diseases during pregnancy are usually managed by conventional anticoagulation and patients are at high risk of pulmonary embolism. Inferior Vena Cava (IVC) filters can be used in cases of documented pulmonary embolism (PE) where anticoagulation is contraindicated or has failed. In our case the patient was diagnosed as having a deep vein thrombosis (DVT) and was started on anticoagulant therapy. Twenty four hours afterwards she went into labor and an IVC filter was inserted due to the risk of pulmonary embolism. She was managed successfully during labor and postpartum period. This shows that IVC filters can be used during labor to try and prevent pulmonary emboli.     

Placement of a vena cava filter in term pregnancy: case report and review of the literature

During pregnancy there are hemostatic changes that may result in a hypercoagulable state producing thrombotic consequences. This condition may be aggravated in women who are carriers of congenital thrombophilic factors. These factors may increase obstetric complications such as miscarriages, fetal growth restriction, placental abruption and preeclampsia. Trombophilic factors may also cause venous thromboembolism, which is the leading cause of maternal morbidity and mortality. We report a case of a 22-year-old woman with factor V Leiden mutation, whose pregnancy was complicated with deep venous thrombosis requiring placement of a vena cava filter.     

Experience with the Cardial inferior vena cava filter as prophylaxis against pulmonary embolism in pregnant women with extensive deep venous thrombosis.

OBJECTIVE: To report the use of the Cardial inferior vena caval filter as prophylaxis against pulmonary embolism in pregnant women with extensive iliofemoral thrombosis. SETTING: Leicester Royal Infirmary. SUBJECTS: Four pregnant women with extensive iliofemoral thrombosis, deemed to be at high risk of pulmonary embolism, managed over a period of one year. TECHNIQUE: In addition to standard full anticoagulation with heparin, the Cardial inferior vena cava filter was introduced percutaneously under local anaesthesia through the unaffected contralateral femoral vein and positioned in the inferior cava below the renal veins. RESULTS: The procedure was uncomplicated and did not compromise feto-maternal condition. There was no evidence of pulmonary embolism after filter insertion. CONCLUSION: The use of inferior vena cava filters should be considered as an adjunct to intravenous anticoagulation in pregnant women with extensive deep vein thrombosis of the lower limbs.     

New criteria for placement of a prophylactic vena cava filter

In order to identify patients who, having had an initial pulmonary embolism, are likely to develop recurrent emboli despite adequate anticoagulation therapy, ten patients (group 1) with documented recurrent pulmonary embolism during anticoagulation therapy were compared with 31 patients (group 2) who showed no evidence of recurrent emboli during the treatment period. Risk factors for thromboembolic disease were similar between the two groups. Noninvasive venous studies of the lower extremities, including Doppler venous ultrasound and phleborheography (PRG), were performed upon all patients after the initial embolic event. Of the ten patients in group 1, seven (70 per cent) had clinical signs of deep vein thrombosis (DVT). Doppler studies were positive for eight of the nine patients studied, and PRG studies were positive for eight of eight patients tested. In contrast, of the 31 patients who responded well to medical therapy, one patient (3 per cent) had clinical signs of DVT, three patients (10 per cent) had positive Doppler studies and one patient (3 per cent) had a positive PRG. Combined Doppler and PRG studies were positive in 100 per cent of the patients in group 1 but in only 6 per cent of the patients in group 2 (p less than 0.001). The results of this study suggest that patients having an initial pulmonary embolism and DVT of sufficient extent detected by noninvasive studies may be at an increased risk for recurrent PE despite anticoagulation therapy. Insertion of a vena cava filter should be considered in these patients prior to the second embolic event.