[Management of postpartum ovarian vein thrombosis. The experience of Amiens university hospital]

Abstract

Objectives: Postpartum ovarian vein thrombophlebitis is an uncommon complication that may threaten mothers' lives. The extension of thrombosis in the inferior vena cava causes a pulmonary embolisme risk and requires urgent care. The main objective of this study was, from a series of patients, to determine the clinical and paraclincal signs to suggest the diagnosis of postpartum ovarian vein thrombosis. Secondary objectives were to assess the location and extent of thrombosis and the therapeutic management of this disease at the University Hospital of Amiens.

Methods: A retrospective study was performed in the Obstetrics and Gynecology department of Amiens University Hospital between January 2011 and May 2015. Were included in this study all patients for whom the diagnosis of postpartum ovarian thrombophlebitis was confirmed by computed tomography.

Results: Thirteen patients had postpartum thrombosis of the ovarian vein. The incidence of this disease in our series was 0.13%. The average age of patients was 30 years. The median onset of symptoms was located on the 4th day; in 92% of cases, they appeared within 10 days after delivery. The clinical picture was not specific and the main symptoms were fever (46.1%) and abdominal pain (53.8%). Biologically inflammatory syndrome was commonly found with elevated leukocytes and CRP. Bacteriological samples were in most cases negative. Sixty-nine percent of lesions concerned the right ovarian vein; 23% had renal extension, 53.8% had inferior vena cava extension and 23% got complicated with pulmonary embolism. No maternal deaths were reported. One hundred percent of patients received anticoagulation at curative dose, the mean duration of which was 6 months. In all, 84.6% of patients received in combination antibiotic therapy with oral and parenteral initially broad spectrum.

Conclusion: Ovarian postpartum thrombosis is a rare complication that must be evoked and sought, especially in front of a non-septic febrile abdominal pain syndrome in postpartum.

Keywords: Fever; Fièvre; Ovarian vein; Post-partum; Postpartum; Thrombophlebitis; Thrombophlébite; Veine ovarienne.