Witlin A G, Sibai B M
Department of Obstetrics and Gynecology, University of Tennessee, Memphis, USA.
Obstet Gynecol. 1995 May;85(5 Pt 1):775-80. doi: 10.1016/0029-7844(95)00040-x.
To review and characterize the presentation of postpartum ovarian vein thrombosis after vaginal delivery.
We reviewed medical records of patients with the prior diagnosis of septic pelvic thrombophlebitis, deep vein thrombosis, and pulmonary embolism associated with pregnancy. The study covered the 10-year period from July 1984 through August 1994 and included women hospitalized at E.H. Crump Women's Hospital, Regional Medical Center, University of Tennessee, Memphis, Tennessee.
During the study period, there were 76,858 deliveries: 13,109 cesareans and 63,749 vaginal deliveries. Eleven patients had documented postpartum ovarian vein thrombosis after vaginal delivery. Ten patients were readmitted an average of 7.6 days after delivery (range 3-17). The diagnosis was documented by computed tomography (CT) scan or ultrasound in ten women and laparotomy in one. Nine patients were readmitted with the presumptive diagnosis of endometritis, the other two with the presumptive diagnosis of pyelonephritis. Nine were treated initially with ampicillin, gentamicin, and clindamycin. Heparin therapy was added when failure of clinical response was noted. No patient defervesced within 24 hours of beginning heparin therapy; only two patients defervesced within 48 hours, and the remaining patients became afebrile at an average of 6.8 days (range 4-18, median 5).
The diagnosis of ovarian vein thrombosis should be considered early in the care of patients readmitted with a diagnosis of endometritis after vaginal delivery. If prompt defervescence does not occur with aggressive intravenous antibiotic therapy, a CT scan should be obtained in a timely manner for prompt diagnosis and therapy. Our findings do not support the time-honored rule that septic pelvic thrombophlebitis and ovarian vein thrombosis respond within 24-48 hours to therapeutic anticoagulation with heparin.
回顾并描述阴道分娩后产后卵巢静脉血栓形成的表现。
我们回顾了先前诊断为与妊娠相关的脓毒性盆腔血栓性静脉炎、深静脉血栓形成和肺栓塞患者的病历。该研究涵盖了1984年7月至1994年8月的10年期间，纳入了在田纳西州孟菲斯市田纳西大学区域医疗中心E.H. Crump妇女医院住院的女性。
在研究期间，共有76,858例分娩：13,109例剖宫产和63,749例阴道分娩。11例患者在阴道分娩后被记录有产后卵巢静脉血栓形成。10例患者在分娩后平均7.6天（范围3 - 17天）再次入院。10名女性通过计算机断层扫描（CT）或超声确诊，1名通过剖腹手术确诊。9例患者因疑似子宫内膜炎再次入院，另外2例因疑似肾盂肾炎再次入院。9例最初接受氨苄西林、庆大霉素和克林霉素治疗。当注意到临床反应不佳时加用肝素治疗。开始肝素治疗后24小时内无患者退热；仅2例患者在48小时内退热，其余患者平均在6.8天（范围4 - 18天，中位数5天）退热。
对于阴道分娩后因子宫内膜炎诊断再次入院的患者，应尽早考虑卵巢静脉血栓形成的诊断。如果积极的静脉抗生素治疗不能迅速退热，应及时进行CT扫描以迅速诊断和治疗。我们的研究结果不支持脓毒性盆腔血栓性静脉炎和卵巢静脉血栓形成在24 - 48小时内对肝素治疗性抗凝有反应这一长期以来的规则。
