II. Causes
- Common
- Pelvic Inflammatory Disease
- Postpartum Complication (e.g. Postpartum Endometritis)
- Cesarean Section (1 in 800 deliveries)
- Vaginal Delivery (1 in 9000 deliveries)
- Uncommon
- Post-operative Hysterectomy
- Pelvic Neoplasm
III. Types
- Deep Septic Pelvic Thrombophlebitis (DSPT)
- Ovarian Vein Thrombophlebitis (OVT)
IV. Findings:
-
Fever
- Onset within 3-5 days of delivery for DPST, and within 7 days of delivery for OVT
- Postpartum Fever is often the only presenting symptom in Deep Septic Pelvic Thrombophlebitis (DSPT)
- Fever is often refractory to Antibiotics
-
Abdominal Pain
- Often absent for Deep Septic Pelvic Thrombophlebitis (DSPT)
- Unilateral abdominal or Pelvic Pain, back pain or Flank Pain
V. Labs
VI. Imaging
- Precautions
- Negative imaging does not exclude Pelvic Vein Thrombophlebitis
-
Ultrasound
- Evaluate for other causes of Postpartum Fever
- CT or MRI (esp. MRI Venography)
- Pelvic Vein intraluminal filling defect
VII. Differential Diagnosis
- Appendicitis
- Postpartum Endometritis
- Urinary infection
- Ovarian Torsion
- Pelvic abscess
- Pelvic Inflammatory Disease
VIII. Management
-
Anticoagulation
- Limited evidence for adequate duration (2-6 weeks)
- Start with Heparin (e.g. Enoxaparin)
- Transition to Warfarin or DOAC (e.g. Apixaban)
-
Antibiotic Management
- Similar to Postpartum Endometritis
- Preferred regimens
- Piperacillin-Tazobactam (Zosyn) 4.5 g IV every 8 hours OR
- Ceftriaxone 2 g IV every 24 hours and Metronidazole 500 mg IV every 8 hours OR
- Imipenem or Meropenem if ESBL or other multi-drug resistant Gram Negative Bacteria suspected
- Alternative regimens
- Ciprofloxacin 400 mg IV every 12 hours and Metronidazole 500 mg IV every 8 hours
IX. Complications
- Venous Thromboembolism (uncommon)
X. References
- (2018) Sanford Guide, accessed on IOS, 10/7/2019
- da Silva Cunha (2018) Case Rep Womens Health 17: 5–7 [PubMed]
Images: Related links to external sites (from Bing)
Related Studies
| Concepts | Pathologic Function (T046) |
| SnomedCT | 95449003 |
| English | THROMBOPHLEBITIS PELVIC VEIN, thrombophlebitis of pelvic vein (diagnosis), Thrombophlebitis of pelvic vein, Thrombophlebitis of pelvic vein (disorder), Thrombophlebitis pelvic vein |
| Dutch | tromboflebitis bekken venen |
| French | Thrombophlébite pelvienne, THROMBOPHLEBITE PELVIENNE |
| German | Thrombophlebitis Beckenvenen, THROMBOPHLEBITIS BECKENVENE |
| Italian | Tromboflebite di vena pelvica |
| Portuguese | Tromboflebite das veias pélvicas, TROMBOFLEBITE DAS VEIAS PELVICAS |
| Spanish | Tromboflebitis de vena pélvica, TROMBOFLEBITIS VENAS PELVIANAS, tromboflebitis de la vena pélvica (trastorno), tromboflebitis de la vena pélvica |
| Japanese | 血栓性骨盤静脈炎, ｹｯｾﾝｾｲｺﾂﾊﾞﾝｼﾞｮｳﾐｬｸｴﾝ |
| Czech | Tromboflebitida pánevní žíly |
| Hungarian | Pelvikus vena thrombophlebitise |
Ontology: Postpartum pelvic thrombophlebitis (C0269953)
| Concepts | Pathologic Function (T046) |
| ICD10 | O87.1 |
| SnomedCT | 67486009 |
| English | Pelvic thrombophlebitis, postpartum, venous complic in preg/puerperium - postpartum pelvic thrombophlebitis, Postpartum pelvic thrombophlebitis (diagnosis), Postpartum pelvic thrombophlebitis, Postpartum pelvic thrombophlebitis (disorder), pelvis; thrombophlebitis, postpartum, thrombophlebitis; pelvic, postpartum |
| Dutch | bekken; tromboflebitis, post partum, tromboflebitis; bekken, post partum |
| Spanish | tromboflebitis pélvica posparto, tromboflebitis pélvica postparto (trastorno), tromboflebitis pélvica postparto |
Ontology: Thrombophlebitis of iliac vein (C0347887)
| Concepts | Disease or Syndrome (T047) |
| SnomedCT | 195428003, 312587007, 42861008 |
| English | Thrombophleb.iliac vein unspec, Thrombophlebitis of the iliac vein unspecified, thrombophlebitis of iliac vein (diagnosis), thrombophlebitis of iliac vein, Thrombophlebitis of the iliac vein unspecified (disorder), Thrombophlebitis of iliac vein, Thrombophlebitis of iliac vein (disorder) |
| Spanish | tromboflebitis de la vena ilíaca, no especificada (trastorno), tromboflebitis de la vena ilíaca, no especificada, tromboflebitis de la vena ilíaca (trastorno), tromboflebitis de la vena ilíaca |
Ontology: Thrombophlebitis septic pelvic (C0860283)
| Concepts | Pathologic Function (T046) |
| Dutch | tromboflebitis septisch van het bekken, septische bekkenstreektromboflebitis |
| French | Thrombophlébite pelvienne septique |
| German | Thrombophlebitis, septisch, Becken, septische Thrombophlebitis des Beckens |
| Italian | Tromboflebite pelvica settica, Tromboflebite settica della pelvi |
| Portuguese | Tromboflebite séptica pélvica, Tromboflebite pélvica séptica |
| Spanish | Tromboflebitis pélvica séptica, Tromboflebitis séptica pélvica |
| Japanese | 化膿性骨盤血栓静脈炎, ｶﾉｳｾｲｺﾂﾊﾞﾝｹｯｾﾝｼﾞｮｳﾐｬｸｴﾝ |
| Czech | Septická pánevní tromboflebitida |
| English | Septic pelvic thrombophlebitis, Thrombophlebitis septic pelvic |
| Hungarian | Thrombophlebitis, septikus, pelvikus, Septicus pelvikus thrombophlebitis |
