[Postpartum ovarian vein thrombophlebitis revealed by pulmonary signs]

[Postpartum ovarian vein thrombophlebitis: diagnosis, treatment and follow-up. Retrospective study over 10 years]

INTRODUCTION

Postpartum ovarian vein thrombosis (POVT) is a rare but serious postpartum complication that can be life-threatening due to its embolic and septic risks. The clinical and paraclinical diagnosis is difficult because of the non-specific signs and the absence of a gold standard for imaging. There is no consensus in the literature on the treatment and follow-up of these patients. The primary objective was to specify the clinical and paraclinical signs suggestive of POVT in order to improve the diagnostic delay. The secondary objectives were to describe the extent of POVT and the proposed immediate therapeutic management.

METHODS

This was a 10-year retrospective study in a type III maternity hospital, from January 2010 to December 2019, where all patients with an imaging-confirmed diagnosis of POVT were included. We analysed the clinical and paraclinical data and the follow-up of the patients.

RESULTS

We included 9 patients with a diagnostic confirmation by imaging. The mean time from first symptoms to diagnosis was 3.3 days (±3.5 days), and only 2 patients (22.2 %) had been diagnosed with POVT before imaging. All patients received curative anticoagulation and 77.8 % (n=7) received antibiotic therapy for POVT. Two patients had a complicated form, 1 with a pulmonary embolism and 1 with a urinary tract compression requiring a urinary diversion with a double J catheter. Five patients (55.6 %) had a thrombophilia check-up.

CONCLUSION

The diagnosis of POVT is difficult and needs to be evoked in front of a painful symptomatology or a fever in postpartum. It can be made by ultrasound, but the injected CT scan specifying the specific search for a POVT remains the imaging examination of choice in order to confirm the diagnosis and eliminate differential diagnoses. Under curative anticoagulation and broad-spectrum antibiotic therapy, the clinical course is generally very favourable. A consultation with an internist makes it possible to define instructions for a subsequent pregnancy.

Postpartum ovarian vein thrombophlebitis: Report of a case and review of the literature

Context:

Postpartum ovarian vein thrombophlebitis is an uncommon life-threatening situation. It should be systematically evoked in case of persistent fever during the postpartum. Diagnosis is often not immediately apparent clinically and there are many that mimic this condition.

Case Report:

A 26-year-old female presented with fever and acute right loin pain during four days after delivery. Right ovarian venous thrombosis was demonstrated on sonography and confirmed with computed tomography. The patient was given antibiotics and anticoagulation therapy with good response.

Conclusion:

Search for postpartum ovarian vein thrombophlebitis should be undertaken in patients with persistent fever. Treatment is more often medical.