Use of a retrievable suprarenal inferior vena cava filter as a primary intervention for postpartum ovarian vein thrombosis: a case report

BACKGROUND: Postpartum ovarian vein thrombosis is a rare diagnosis with a significant associated risk of pulmonary embolism. The mainstay of therapy consists of intravenous antibiotics and anticoagulation. CASE: A 30-year-old woman presented with fever and abdominal pain 3 days after cesarean section and was found to have an ovarian vein thrombosis on computed tomography. Given her history of cerebral arteriovenous malformation and the attendant risk for cerebral hemorrhage with the use of anticoagulation, she was successfully treated with a removable suprarenal inferior vena cava (IVC) filter and intravenous antibiotics. CONCLUSION: For patients who fail to respond to anticoagulation alone or in whom anticoagulation is contraindicated, placement of a retrievable suprarenal IVC filter is a viable treatment option in the setting of postpartum ovarian vein thrombosis.     

Trombosis de vena ovárica y vena cava inferior asociada a endometritis en el puerperio

Ovarian vein thrombosis is a rare and severe puerperal complication that usually manifests as fever and abdominal pain in the puerperal period and is more frequent in women who have undergone cesarean section. There is an associated high risk of pulmonary embolism and thus early diagnosis and treatment are required. We report the case of a 30-year-old woman with pelvic pain and fever in the puerperal period. Computed tomography scan revealed ovarian vein thrombosis extending to the inferior vena cava. Endometritis was also diagnosed. The patient received dalteparin and antibiotics. Ovarian vein thrombosis should be included in the differential diagnosis of fever in the postpartum period.     

Postpartum ovarian vein thrombosis: an unpredictable event: two case reports and review of the literature

Ovarian vein thrombosis (OVT) is a rare but serious postpartum complication that, in most cases, occurs in the right ovarian vein. Certain diagnosis, following clinical suspect because of lower quadrant tenderness and fever that alone does not respond to adequate broad-spectrum antibiotics, is now based on computed tomography (CT), although other imaging techniques, such as color Doppler ultrasonography and magnetic resonance (MR) imaging, are useful. Heparin and intravenous antibiotics are the mainstay of treatment so as to avoid laparotomy. We report on the management of two cases of postpartum OVT.     

Trombosis de la vena ovárica con extensión a la vena cava inferior en el posparto

Ovarian vein thrombosis is a complication that can appear during the postpartum period or after pelvic surgery. This complication is a rare but serious entity requiring early diagnosis and treatment and should be suspected in patients with fever and acute abdominal pain at the beginning of the postpartum. Imaging diagnosis with contrast computed tomography remains the gold standard. Administration of broad-spectrum antibiotics and heparin therapy produces immediate clinical improvement.     

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.     

Renal vein thrombosis following puerperal ovarian vein thrombophlebitis

A case of renal vein thrombosis following puerperal ovarian vein thrombophlebitis is reported. We review the syndrome of puerperal ovarian vein thrombophlebitis and emphasize the potential for renal vein and vena caval involvement. The utility of computed tomographic scanning for diagnostic confirmation of this postpartum complication is described.     

Trombosis de la vena ovárica: casuística en 5 años y revisión de la literatura

The ovarian vein thrombosis (OVT) is a rare but serious complication in the postpartum. It affects between 0.02% and 0.2% of all pregnancies, from 0.02% to 0.18% of vaginal deliveries and between 1% and 2% of caesarean sections. In up to 90% of cases it affects the right ovarian vein and it may extend as far as the inferior vena cava, causing serious complications. Early diagnosis and treatment are crucial. We present the cases of ovarian vein thrombosis having occurred in the postpartum period during the last 5 years in the Complejo Hospitalario de Pontevedra and a review of existing literature.     

Diagnostic imaging in puerperal febrile morbidity

This retrospective study was conducted to assess the value of imaging in patients with refractory puerperal febrile morbidity. During a 36-month period, 31 patients were referred for ultrasound and/or computed tomography or magnetic resonance imaging because of postpartum fever unresponsive to broad-spectrum antibiotic therapy of at least 72 hours' duration. Hematomas were identified in 11 women. Abscesses were diagnosed in seven patients, ovarian venous thrombosis in two, vesicouterine fistula in one, small-bowel obstruction in one, and a subcutaneous seroma in one. Twenty-one women had endomyometritis, 13 of whom also had other extrauterine abnormalities (abscess in six, hematoma in four, and ovarian venous thrombosis, vesicouterine fistula, and small-bowel obstruction in one each). Retained placental tissue was found in two women with endomyometritis. Only two subjects had negative imaging studies. In most patients, imaging led to definitive diagnosis and specific therapeutic measures resulting in resolution of the febrile morbidity. Our experience suggests that these imaging techniques may be helpful in evaluating puerperal fever.     

Postpartum ovarian vein thrombosis: an update

Ovarian vein thrombosis (OVT) is a rare complication of pregnancy. However, recognition and treatment is critical because a delay in diagnosis could lead to significant maternal morbidity. The diagnosis of OVT remains a challenge because there is no known profile of risk factors. Current controversies concern radiologic diagnosis, appropriate treatment strategies including antibiotics and anticoagulation, treatment duration, and testing for thrombophilias. TARGET AUDIENCE: Obstetricians & Gynecologists, Family Physicians. LEARNING OBJECTIVES: After completion of this article, the reader should be able to explain that even though the occurrence of postpartum ovarian vein thrombosis (OVT) is rare the physician must consider it in a differential diagnosis in a patient with postdelivery fever unresponsive to antibiotics, state that missing the diagnosis can have devastating consequences, and recall that at times it is difficult to differentiate from septic thrombophlebitis.     

Computed tomographic features of puerperal ovarian vein thrombosis

Puerperal ovarian vein thrombosis is a dangerous complication of childbirth and often leads to inferior vena cava thrombosis and multiple pulmonary emboli. Computed tomography of the abdomen is useful in early diagnosis. Two patients with typical computed tomographic features are presented.     

Antibiotikaresistentes Fieber im Wochenbett

Septic pelvic thrombophlebitis is a rare disease (<0.1% total births) but the incidence is much higher after cesarian section. Disposition factors are a dilatation of the ovarian veins with simultaneous rapidly sinking venous blood pressure postpartum and increased rate of coagulation. Early imaging is barely possible so that the clinical diagnosis remains the critical factor. The treatment of choice is broad spectrum antibiotics (effective against Streptococceae, Enterobacteriaceae and anerobic pathogens) combined with therapeutic anticoagulation. The risks of septic pelvic thrombophlebitis are spreading of the thrombus into the inferior vena cava and the renal veins, pulmonary embolism and generalised sepsis. Typical symptoms are high fever despite antbiotic therapy, astounding freedom from pain between fever attacks and greatly increased inflammation parameters. For the most important differential diagnosis, primary ovarian vein thrombosis, the main symptom is postpartal lower abdominal pain and fever does not occur in 40-60% of cases. Later complications are not to be expected and an increased tendency to thrombosis is not present during subsequent pregnancies.     

Ovarian vein thrombosis associated with a tubo-ovarian abscess

We present a case of ovarian vein thrombosis associated with a tubo-ovarian abscess diagnosed by computed tomography in a nonpuerperal patient. Received: 29 May 1997 / Accepted: 8 August 1997     

Trombosis venosa ovárica posparto: una causa inusual de fiebre puerperal

Postpartum ovarian vein thrombosis is a rare and unpredictable complication that requires a high index of clinical suspicion. Its early diagnosis and management, with a multidisciplinary approach, are essential in order to avoid unnecessary surgeries and possible serious complications. Its usual clinical presentation is often persistent fever and abdominal pain, generally in the first week postpartum. A report is presented on three representative cases that were diagnosed in our centre between 2014 and 2019, presenting predisposing factors, diagnosis, management, and outcome of these patients.     

Late-onset puerperal ovarian vein thrombophlebitis treated laparoscopically

Puerperal ovarian vein thrombophlebitis is an uncommon condition that usually develops in the immediate postpartum period. Computed tomography, magnetic resonance imaging, Doppler ultrasound, and exploratory laparotomy may be performed to diagnose it. A woman developed worsening abdominal pain 6 weeks postpartum. Laparoscopic intervention allowed treatment of late-onset, left-sided puerperal ovarian vein thrombophlebitis. The disorder may develop much later after delivery than expected and can be successfully treated laparoscopically.     

Computed tomography in diagnosis of puerperal ovarian vein thrombosis

The syndrome of puerperal ovarian vein thrombosis is often a diagnostic enigma. In the past, laparotomy has been the most frequent modality used to establish the diagnosis. The clinical picture and characteristic mass have not accurately predicted the presence of this syndrome, resulting in potentially dangerous and unnecessary surgery. The use of computed tomography is suggested as a noninvasive ancillary method.     

Die septische Ovarialvenenthrombose — Diagnostik und Therapie

Septic ovarian vein thrombosis is commonly the sequela of puerperal purulent endomyometritis. The incidence has been reported to be 1 in 600-6000 deliveries. The predominant location is the right ovarian vein according to the puerperal uterine drainage. The diagnostic and therapeutic experience in 9 cases is described. The leading symptoms were abdominal pain localized at the psoatic muscle and a tender, barrel-shaped tumor. Ultrasound and computed tomography (CT) added in the correct preoperative diagnosis. Antibiotic therapy and anticoagulation are recommended in an uneventful course; in complicated cases surgical intervention becomes mandatory.     

Puerperal pelvic thrombophlebitis: impact on diagnosis and treatment using x-ray computed tomography and magnetic resonance imaging

The clinical diagnosis of puerperal pelvic thrombophlebitis was confirmed by x-ray computed tomography in 11 women, and further documented in six by magnetic resonance imaging. Venous thrombi were demonstrated in ovarian, iliofemoral, and inferior vena caval vessels. In six women with ovarian vein involvement and no evidence of iliofemoral thrombophlebitis, resolution followed intravenous antimicrobial therapy alone, and in three of these, resolution was confirmed by x-ray tomography. In contrast, three of five women with symptomatic iliofemoral thrombophlebitis had a prolonged febrile course despite antimicrobial and heparin therapy. The clinical courses of these 11 women were consistent with the observation that pelvic thrombophlebitis is associated with pelvic infection. Disease manifested within a few days after parturition was more likely due to ovarian vein involvement, whereas disease with later onset of symptoms was more likely due to iliofemoral thrombosis, with or without vena caval extension. Through the use of x-ray computed tomography and magnetic resonance imaging, the natural course of pelvic thrombophlebitis can be better elucidated and therapeutic regimens more clearly evaluated.     

Diagnosis of puerperal ovarian vein thrombophlebitis by computed tomography

A case of puerperal ovarian vein thrombophlebitis diagnosed by computed tomography is presented. Resolution after treatment with antibiotics and anticoagulation is demonstrated. The obstetrician must be aware of the role of computed tomography in making a prompt and accurate diagnosis in such cases.     

Septic pelvic thrombophlebitis or refractory postpartum fever of undetermined etiology

The objective of this study was to review and characterize the presentation, diagnostic dilemmas, management, and prognosis of postpartum septic pelvic thrombophlebitis. Medical records of postpartum women with the diagnosis of septic pelvic thrombophlebitis were reviewed for the 8-year period 1986–1994. Cases of documented ovarian vein thrombosis or those with other pelvic pathology on imaging study were excluded. Thirty-one women, four following vaginal delivery and 27 following cesarean delivery, with a final diagnosis of septic pelvic thrombophlebitis were identified. All patients demonstrated refractory febrile morbidity (mean 5.5 ± 1.9 days prior to instituting heparin therapy) despite multiagent antimicrobial therapy with ampicillin, gentamicin, and clindamycin. Imaging studies (CT and/or ultrasound) were performed in 20 women and revealed no pelvic pathology. The patients required an average of 4.7 ± 2.1 days (median 5, range 1–9 days) of heparin therapy before defervescence. Heparin levels were therapeutic at a mean of less than 24 h (range 6–24 h). The average dose of heparin required was 16.0 ± 3.0 U/kg/h. Nine women had 13 subsequent pregnancies without recurrent thromboembolic complications. Currently available imaging studies cannot diagnose the entity we now define as septic pelvic thrombophlebitis (once cases of ovarian vein thrombosis are excluded). Our findings do not support the time-honored rule that septic pelvic thrombophlebitis responds within 24–48 h to therapeutic anticoagulation with heparin. Therefore, criteria other than imaging studies or immediate defervescence following heparin therapy are necessary for diagnosis of septic pelvic thrombophlebitis. A more appropriate terminology for septic pelvic thrombophlebitis should be refractory postpartum fever of undetermined etiology.     

A case of septic ovarian vein thrombosis

Puerperal ovarian vein thrombosis commonly originates from purulent necrotic endomyometritis. The incidence is published to be 1 to 600 deliveries. According to the puerperal uterine drainage, the predominant location is the right ovarian vein in 90% of all cases. The leading symptoms are lower abdominal pain, fever and leucocytosis. Discrepancy between the given clinical picture and the insignificant findings on gynaecologic examinations is common.