New observations in postpartum ovarian vein thrombosis: experience of single center.

The diagnosis of postpartum ovarian vein thrombosis (POVT) has become more accurate since the introduction of modern imaging techniques. We performed a prospective study at a single Medical Center in order to define the incidence and risk factors for POVT. Thirteen consecutive women with POVT were enrolled during a period of 4 years. Each participant underwent a computerized tomography scan for diagnosis followed by a profile for congenital and acquired thrombophilia. A detailed history of pregnancy, labor and state after delivery was obtained within 2 days of diagnosis while the patient was still hospitalized. The incidence of POVT was four of 30,749 vaginal deliveries, nine of 9604 cesarean deliveries and six of 906 twin deliveries by cesarean section. The odds ratio for developing POVT was 21.37 for twin delivery versus singleton and 7.2 for cesarean section versus vaginal delivery. Of the 13 women with POVT, infection was found in seven women (53%) and other clinical risk factors in four (30%). Only three (23%) participants were found to have thrombophilia and one developed POVT while on enoxaparin treatment. Our results suggest that the risk for maternal POVT is increased by cesarean section delivery of twins. It appears that investigations for thrombophilia are unnecessary when POVT is the sole manifestation of thrombosis.

Management and outcome of pregnancy in women with thrombophylic disorders and past cerebrovascular events.

OBJECTIVE: To evaluate the maternal and fetal outcome in a cohort of women undergoing a subsequent pregnancy after a previous cerebrovascular event in the presence of thrombophilia. PATIENTS: Fifteen pregnancies were followed up in 12 women with past cerebrovascular events and thrombophilic disorders. The cerebrovascular events occurred during a previous pregnancy in five patients. Six patients had a bad obstetric history including intrauterine fetal death in four cases, early onset of severe preeclampsia in two cases and one infant that was small for gestational age. THE THROMBOPHILIC DISORDERS INCLUDED: anti-phospholipid syndrome, protein C, S or antithrombin III deficiencies, mutations of the methyltetrahydrofolate reductase (MTHFR). All patients received prophylactic treatment with low molecular weight heparin and low dose aspirin. RESULTS: Thromboembolic complications occurred in four pregnancies. Postpartum complications occurred in one patient; deep vein thrombosis and pulmonary emboli after stopping anticoagulation treatment. No patient had long-term neurologic damage. All pregnancies except one resulted in live births. (mean gestational age at delivery 36 +/- 3. 7 weeks, mean birth weight 2656 +/- 811 g). The one remaining pregnancy was electively terminated. There was one neonatal death due to the complications of severe prematurity in a woman with severe HELLP syndrome. CONCLUSION: This preliminary data suggests that women with a history of cerebrovascular events and thrombophilic disorders receiving prophylactic treatment, have a relatively favorable pregnancy outcome; however, they remain at significant risk during pregnancy. Further studies are necessary to determine the optimal prophylactic treatment.