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Pelvic Vein Thrombophlebitis
Aka: Pelvic Vein Thrombophlebitis, Iliac Vein Thrombophlebitis, Postpartum Pelvic Thrombophlebitis, Septic Pelvic Thrombophlebitis, Suppurative Pelvic Thrombophlebitis, Ovarian Vein Thrombophlebitis
- 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
- Types
- Deep Septic Pelvic Thrombophlebitis (DSPT)
- Ovarian Vein Thrombophlebitis (OVT)
- 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
- Labs
- Complete Blood Count
- Mild Leukocytosis
- Blood Culture
- Test Sensitivity <33%
- 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
- Differential Diagnosis
- Appendicitis
- Postpartum Endometritis
- Urinary infection
- Ovarian Torsion
- Pelvic abscess
- Pelvic Inflammatory Disease
- 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
- Complications
- Venous Thromboembolism (uncommon)
- References
- (2018) Sanford Guide, accessed on IOS, 10/7/2019
- da Silva Cunha (2018) Case Rep Womens Health 17: 5–7 [PubMed]
- https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5869062/