Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Case Reports
. 2013 Feb 22;11(1):4.
doi: 10.1186/1477-9560-11-4.

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

Leslie Fiengo  1 , Federico Bucci, Gregorio Patrizi, Domenico Giannotti, Adriano Redler
Affiliations
Case Reports

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

Leslie Fiengo et al. Thromb J. .

Abstract

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.

PubMed Disclaimer

Figures

Figure 1
Figure 1
Abdominal Computed Tomography showing complete thrombosis of Inferior Vena Cava.
Figure 2
Figure 2
CT-scan showing complete thrombosis of IVC, right ovarian vein and pelvic varicosity.
See this image and copyright information in PMC

References

    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. - PubMed
    1. Marik PE, Plante LA. Venous thromboembolic disease and pregnancy. N Engl J Med. 2008;359(19):2025–2033. doi: 10.1056/NEJMra0707993. - DOI - PubMed
    1. 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. - PubMed
    1. Suleyman T, Gultekin H, Abdulkadir G. 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):680–682. - PubMed
    1. 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. - PubMed

Publication types

LinkOut - more resources