Postpartum deep vein thrombosis and pulmonary embolism in twin pregnancy: undertaking of clinical symptoms leading to massive complications

Thrombosis Journal

Adriano Redler²  Domenico Giannotti²  Gregorio Patrizi²  Federico Bucci³  Leslie Fiengo¹ 

[1] Dipartimento Scienze Chirurgiche-Università La Sapienza, Viale Regina Elena, 324-00161, Rome, Italy;Department of Vascular Surgery, La Sapienza University of Rome, Rome, Italy;Vascular Surgery Department, Centre Hospitalier Sud Gironde, Langon, France

关键词: Pulmonary emboli;    Postpartum ovarian vein thrombosis;    Twin delivery;   

Others  :  838668
DOI  :  10.1186/1477-9560-11-4

 received in 2012-08-24, accepted in 2013-02-03,  发布年份 2013

【 摘 要 】

Background

Deep Vein Thrombosis (DVT) is an important cause of morbidity and is the first cause of maternal death after delivery in Western Nations. The risk of venous thromboembolism is present throughout the pregnancy and is maximal during postpartum, especially after twin delivery. Many of the signs and symptoms of DVT overlap those of a normal pregnancy causing difficulty for diagnosis.

Case report

We report the case of a 33 year-old woman transferred to our Department one week after caesarean section for twin delivery. She presented with severe abdominal pain, fever, abdominal distension and shortness of breath. She had no personal or family history of thromboembolism. Computerized Tomography Scan revealed right ovarian vein thrombosis, left renal vein thrombosis extending up to the Inferior Vena Cava and pulmonary embolism with bilateral pleural effusion. Caval filter was positioned and anticoagulation therapy associated with antibiotics was instituted. Pancreatitis showed up two days after and was promptly treated. Three months after discharge the caval filter was removed and oral anticoagulation was stopped. During a 12-months follow-up, she remained stable and symptom free.

Results

Ovarian vein thrombosis is rare but recognition of signs and symptoms is fundamental to start adequate therapy and avoid potential serious sequelae. The risk for maternal postpartum ovarian vein thrombosis is increased by caesarean section delivery of twins. Such patients should be closely monitored. We illustrated how an underestimated condition can lead to massive complications.

【 授权许可】

   
2013 Fiengo et al; licensee BioMed Central Ltd.

【 图 表 】

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【 参考文献 】

• [1]Bates SM, Greer IA, Pabinger I, Sofaer S, Hirsh J: Venous thromboembolism, thrombophilia, antithrombotic therapy, and pregnancy. American college of chest physicians evidence-based clinical practice guidelines (8th edition) Chest 2008, 133(6):844S-886S.
• [2]Marik PE, Plante LA: Venous thromboembolic disease and pregnancy. N Engl J Med 2008, 359(19):2025-2033.
• [3]Heit JA, Kobbervig CE, James AH, Petterson TM, Bailey KR, Melton LJ III: Trends in the incidence of venous thromboembolism during pregnancy or postpartum: a 30-year population- based study. Ann Intern Med 2005, 143(10):697-706.
• [4]Suleyman T, Gultekin H, Abdulkadir G, et al.: Acute right lower quadrant abdominal pain as the presenting symptom of ovarian vein thrombosis in pregnancy. J Obstet Gynaecol Res 2008, 34(4 Pt 2):680-2.
• [5]Salomon O, Apter S, Shaham D, Hiller N, Bar-Ziv J, Itzchak Y: Risk factors associated with postpartum ovarian vein thrombosis. Thromb Haemost 1999, 82(3):1015-1019.
• [6]Klima DA, Snyder TE: Postpartum ovarian vein thrombosis. Obstet Gynecol 2008, 111(2 Pt 1):431-435.
• [7]Salomon O, Dulitzky M, Apter S: New observations in postpartum ovarian vein thrombosis: experience of single center. Blood Coagul Fibrinolysis 2010, 21(1):16-19.
• [8]Dunnihoo DR, Gallaspy JW, Wise RB, Otterson WN: Postpartum ovarian vein thrombophlebitis: a review. Obstet Gynecol Surv 1991, 46(7):415-427.
• [9]Opara E, Gile J, Zaidi J: Inferior vena cava filter thrombo-prophylaxis in high-risk twin pregnancy. Int J Gynaecol Obstet 2007, 98(1):62-63.
• [10]Eichinger S, Weltermann A, Philipp K, Hafner E, Kaider A: Prospective evaluation of hemostatic system activation and thrombin potential in healthy pregnant women with and without factor V Leiden. Thromb Haemost 1999, 82(4):1232-1236.
• [11]Macklon NS, Greeg IA, Bowmann AW: An ultrasound study of gestational and postural changes in the deep venous system of the leg in pregnacy. Br J Obstet Gynaecol 1997, 104(2):191-197.
• [12]Dessole S, Capobianco G, Arru A, Demurtas P, Ambrosini G: Postpartum ovarian vein thrombosis: an unpredectibale event:two case reports and review of the literature. Arch Gynecol Obstet 2003, 267(4):242-246.
• [13]Kerr MG, Scott DB, Samuel E: Studies of the inferior vena cava in late pregnancy. Br Med J 1964, 1(5382):532-533.
• [14]Kyrle PA, Eichinger S: Deep vein thrombosis. Lancet 2005, 365(9465):1163-1174.
• [15]Torkzad MR, Bremme K, Hellgren M, Eriksson MJ: Magnetic resonance imaging and ultrasonography in diagnosis of pelvic vein thrombosis during pregnancy. Thromb Res 2010, 126(2):107-112.
• [16]Quane LK, Kidney DD, Cohen AJ: Unusual causes of ovarian vein thrombosis as revealed by CT scans sonography. AJR Am J Roentgenol 1998, 171(2):487-490.
• [17]Takash TJ, Cervera RD, Gregoric ID: Ovarian vein and caval thrombosis. Tex Heart Inst J 2005, 32(4):579-582.
• [18]Arya R: How I, manage venous thromboembolism in pregnancy. Br J Haematol 2011, 153(6):698-708.