Subscribe to RSS
DOI: 10.1055/s-0037-1614321
Risk Factors Associated with Postpartum Ovarian Vein Thrombosis
Publication History
Received
26 January 1999
Accepted after revision
12 May 1999
Publication Date:
09 December 2017 (online)
![](https://www.thieme-connect.de/media/10.1055-s-00035024/199903/lookinside/thumbnails/10-1055-s-0037-1614321-1.jpg)
Summary
Thrombosis of the ovarian vein is a remarkable process occuring within a few days of labor in 1:500-1:2000 women. Its presentation is characterized by fever, abdominal pain and occasionally by a palpable abdominal mass that in earlier years sometimes lead to explorative laparotomy. With the advent of modern imaging techniques the diagnosis can be made relatively easily. The pathogenesis has been attributed to an infectious process expanding from the uterus to the right ovarian vein and stasis. A predisposition towards thrombosis has not been so far explored. In this study we retrospectively analysed the clinical features, diagnosis and treatment of 22 patients with objective documentation of post partum ovarian vein thrombosis (POVT) and assessed potential risk factors. In 11 of the 22 patients (50%) inherited prothrombotic risk factors were detected as follows: 4 were heterozygous for factor V G1691 A, 2 had protein S deficiency, one had protein S deficiency and was heterozygous for factor V G1691A, and 4 were homozygous for MTHFR C677T. Eight of the 11 patients who bore a prothrombotic predisposition underwent cesarean section. Taken together, the data suggest that POVT may result from the combined effect of an infection, cesarean section and a prothrombotic tendency.
-
References
- 1 Brown TK, Munsick RA. Puerperal ovarian vein thrombophlebitis: a syndrome. Am J Obstet Gynecol 1971; 109: 263-73.
- 2 Dunnihoo DR, Gallaspy JW, Wise RB, Otterson WN. Postpartum ovarian vein thrombophlebitis: a review. Obstet Gynecol Surv 1991; 46: 415-27.
- 3 Munsick RA, Gillanders LA. A review of the syndrome of puerperal ovarian vein thrombophlebitis. Obstet Gynecol Surv 1981; 36: 57-66
- 4 Gerbasi FR, Bottoms S, Farag A, Mammen EF. Changes in hemostasis activity during delivery and the immediate postpartum period. Am J Obstet Gynecol 1990; 162: 1158-63.
- 5 Ygge J. Changes in blood coagulation and fibrinolysis during the puerperium. Am J Obstet Gynecol 1969; 104: 2-12.
- 6 Stirling Y, Woolf L, North WRS, Seghatchian MJ, Meade TW. Haemostasis in normal pregnancy. Thromb Haemost 1984; 52: 176-82.
- 7 Hellgren M, Blomback M. Studies on blood coagulation and fibrinolysis in pregnancy, during delivery and in the puerperium. Gynecol Obstet Invest 1981; 12: 141-54.
- 8 Twickler DM, Setiawan AT, Evans RS, Erdman WA, Stettler RW, Brown CEL, Cunningham FG. Imaging of puerperal septic thrombophlebitis: prospective comparison of MR imaging, CT and sonography. Am J Roentgenol 1997; 169: 1039-43.
- 9 Savader SJ, Otero RR, Savader BL. Puerperal ovarian vein thrombosis: evaluation with CT, US, and MR imaging. Radiology 1988; 167: 637-9.
- 10 Miller SA, Dykes DD, Polesky HF. A simple salting out procedure of extracting DNA from human nucleated cells. Nucleic Acids Res 1988; 16: 1215.
- 11 Bertina RM, Koeleman BP, Koster T, Rosendaal FR, Dirven RJ, de Ronde H, van der Velden PA, Reitsma PH. Mutation in blood coagulation factor V associated with resistance to activated protein C. Nature 1994; 369: 64-7.
- 12 Frosst P, Blom HJ, Milos R, Goyette P, Sheppard CA, Maatthews RG, Boers GJ, den Heijer M, Kluijtmans LA, van den Heuvel LP, Rozen R. A candidate genetic risk factor for vascular disease: A common mutation in methylenetetrahydrofolate reductase. Nature Genet 1995; 10: 111-3.
- 13 Poort SR, Rosendaal FR, Reitsma PH, Bertina RM. A common genetic variation in the 3’-untranslated region of the prothrombin gene is associated with elevated plasma prothrombin levels and an increase in venous thrombosis. Blood 1996; 88: 3698-703.
- 14 Salomon O, Steinberg DM, Zivelin A, Gitel S, Dardik R, Rosenberg N, Berliner S, Inbal A, Mani A, Lubetsky A, Varon D, Martinowitz U, Seligsohn U. Single and combined prothrombotic factors in patients with idiopathic venous thromboembolism: Prevalence and risk assessment. Arterioscler Thromb Vasc Biol 1999; 19: 511-18.
- 15 Seligsohn U, Zivelin A. Thrombophilia as a multigenic disorder. Thromb Haemost 1997; 78: 297-301.
- 16 Margaglione M, D’Andrea G, d’Addedda M, Giuliani N, Cappucci G, Iannaccone L, Vecchione G, Grandone E, Brancaccio V, Di Minno G. The methylenetetrahydrofolate reductase TT677 genotype is associated with venous thrombosis independently of the coexistence of the FV Leiden and the prothrombin A20210 mutation. Thromb Haemost 1998; 79: 907-11.
- 17 Tosetto A, Missiaglia E, Frezzato M, Rodeghiero F. The VITA project: C677T mutation in the methylene-tetrahydrofolate reductase gene and risk of venous thromboembolism. Br J Haematol 1997; 97: 804-6.
- 18 Kluijtmans LA, den Heijer M, Reitsma PH, Heil SG, Blom HJ, Rosendaal FR. Thermolabile methylenetetrahydrofolate reductase and factor V Leiden in the risk of deep vein thrombosis. Thromb Haemost 1998; 79: 254-58.
- 19 den Heijer M, Koster T, Blom HJ, Bos GM, Briet E, Reitsma PH, Vandenbroucke JP, Rosendaal FR. Hyperhomocysteinemia as a risk factor for deep-vein thrombosis. N Engl J Med 1996; 334: 759-62.
- 20 Jacques PF, Bostom AG, Williams RR, Ellison RC, Eckfeldt JH, Rosenberg IH, Selhub J, Rozen R. Relation between folate status, a common mutation in methyltenetetrahydrofolate reductase, and plasma homocysteine concentrations. Circulation 1996; 93: 7-9.
- 21 Landon MJ, Eyre DH, Hytten FE. Transfer of folate to the fetus. Br J Obstet Gynaecol 1975; 82: 12-9.
- 22 McPartlin J, Halligan A, Scott JM, Darling M, Weir DG. Accelerated folate breakdown in pregnancy. Lancet 1993; 341: 148-9.