Postpartum ovarian vein with inferior vena cava thrombosis: a case report and literature review
10.3760/cma.j.cn113903-20240120-00036
- VernacularTitle:产后卵巢静脉合并下腔静脉血栓形成1例并文献复习
- Author:
Xin YUAN
1
;
Yan LI
;
Dan LUO
;
Jiaxin ZHENG
;
Fengleng YANG
;
Dongmei TANG
Author Information
1. 电子科技大学医学院附属妇女儿童医院（成都市妇女儿童中心医院）产科，成都 610073
- Publication Type:Journal Article
- Keywords:
Venous thrombosis;
Ovary;
Vena cava, inferior;
Pulmonary embolism;
Pregnancy complications
- From:
Chinese Journal of Perinatal Medicine
2024;27(12):1049-1053
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To investigate the clinical characteristics, diagnosis, treatment, and prognosis of postpartum ovarian vein thrombosis (OVT) combined with inferior vena cava thrombosis (IVCT).Methods:A retrospective analysis was conducted on the clinical data of a postpartum OVT case combined with IVCT treated in the Department of Obstetrics of the Affiliated Women's and Children's Hospital, School of Medicine, University of Electronic Science and Technology of China (Chengdu Women and Children's Central Hospital). Chinese literature was searched in CNKI, Wanfang Database, Yiigle, and VIP Database using the keywords "ovarian vein thrombosis," "inferior vena cava thrombosis," and "pregnancy." English literature was searched using the same keywords in PubMed, Embase, and UpToDate databases. The search period was from January 1995 to January 2024. Exclusion criteria were: (1) OVT not combined with IVCT; (2) incomplete clinical data. These cases' clinical characteristics, diagnosis, treatment, and prognosis were analyzed using a descriptive statistical analysis.Results:(1) Case report: The patient, a 31-year-old woman, underwent a full-term cesarean section due to breech presentation and premature rupture of membranes. Three days postoperatively, she developed abdominal pain and right-sided back pain without fever. Ultrasound indicated bilateral renal pelvis separation, and CT angiography revealed right OVT combined with IVCT. She was transferred to the Vascular Surgery Department of West China Hospital, Sichuan University, where she received anticoagulant therapy with nadroparin for 10 days and was discharged in stable condition. She continued oral rivaroxaban anticoagulation therapy after discharge. At a three-month follow-up, the patient reported no discomfort. (2) Literature review: Twenty articles (18 in English and two in Chinese) involving 21 patients were identified. Including the case from our hospital, there were 22 cases in total. The average age of the 22 patients was (29.7±2.5) years, ranging from 16 to 39 years. The onset of the condition postpartum was (6.2±1.9) days, ranging from 1 to 30 days. Sixteen cases (72.7%) were cesarean deliveries, and six cases (27.3%) were vaginal deliveries (including one case with forceps assistance). Fourteen cases (63.6%) had right-sided OVT combined with IVCT, and eight cases (36.4%) had pulmonary embolism and other deep vein thromboses. Symptoms among the 22 patients included fever (14 cases, 63.6%), lower abdominal pain (16 cases, 72.7%), back pain and chest pain (three cases each, 13.6%), dyspnea (two cases, 9.1%), cough, and syncope (one case in each, 4.5%). Five patients were initially diagnosed via ultrasound, and 22 were confirmed through CT scans. Nine patients reported D-dimer levels at the onset of the disease, averaging (2.74±1.01) mg/L. Treatment methods included anticoagulation (22 cases, 100.0%), antibiotics (14 cases, 63.6%), thrombectomy (three cases, 13.6%), placement of inferior vena cava filters (seven cases, 31.8%), and thrombolysis (three cases, 13.6%). The mean time of anticoagulant therapy for the 22 patients was (2.4±0.5) months, ranging from two weeks to six months. One patient developed a rectus sheath hematoma during anticoagulation therapy, which required a one-day cessation of anticoagulation. After stabilization, the therapy was resumed, and both the thrombosis and hematoma were resolved.Conclusions:For postpartum patients presenting with unexplained fever, abdominal pain, low back pain, or chest pain, the possibility of ovarian vein thrombosis should be considered. Consultation with relevant departments and imaging examinations should be conducted when necessary to ensure early detection and treatment.
