Traisrisilp Kuntharee, Manopunya Manatsawee, Srisuwan Tanop, Chankhunaphas Wisit, Tongsong Theera
Department of Obstetrics and Gynecology, Faculty of Medicine, Chiang Mai University, Chiang Mai 50200, Thailand.
Medicina (Kaunas). 2021 Mar 1;57(3):222. doi: 10.3390/medicina57030222.
This study aims to emphasize that asymptomatic patients with undiagnosed and asymptomatic May-Thurner syndrome (MTS) may firstly develop severe compression during pregnancy. A 40-year-old woman, G1P0, at 22 weeks of twin gestation presented with left lower extremity edema and pain. One twin was structurally normal while the other had bilateral renal agenesis with oligohydramnios. Magnetic resonance venography (MRV) revealed severe compression of the left iliac vein by the right iliac artery without evidence of deep vein thrombosis (DVT). Conservative treatment with anticoagulant prophylaxis was instituted throughout the rest of pregnancy and postpartum period. She was also complicated with severe pre-eclampsia, a cesarean section was performed due to a prolapsed cord at 27 weeks of gestation, and she gave birth to a surviving baby weighing 1100 g. In conclusion, this case report provides evidence that pregnancy can disclose a subtle May-Thurner anatomy to be symptomatic without DVT. Successful pregnancy outcomes could be achieved with conservative treatment and anticoagulant prophylaxis.
本研究旨在强调，未诊断出且无症状的梅-图二氏综合征（MTS）的无症状患者在孕期可能首先出现严重压迫症状。一名40岁女性，孕1产0，双胎妊娠22周时出现左下肢水肿和疼痛。其中一个胎儿结构正常，另一个胎儿双侧肾缺如并羊水过少。磁共振静脉造影（MRV）显示右髂动脉严重压迫左髂静脉，无深静脉血栓形成（DVT）证据。在整个孕期剩余时间及产后均采用抗凝预防的保守治疗。她还并发了严重子痫前期，因孕27周时脐带脱垂行剖宫产，产下一名体重1100g的存活婴儿。总之，本病例报告证明，妊娠可使隐匿的梅-图二氏解剖结构出现症状，且无DVT。采用保守治疗和抗凝预防可实现成功的妊娠结局。
