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Pregnancy-related pelvic vein thrombosis

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Pregnancy is a hypercoagulable state due to pro-hemostatic changes in the activity of coagulation factors and fibrinolysis and due to progressively increasing pressure on the iliac veins from the growing uterus. Thus, it is not surprising that there is an increased risk for thrombotic events and especially in the pelvic veins. With the trauma of delivery, and particularly caesarian section, the risk is accentuated in the early days postpartum. Multiparity seems to be another risk factor, which may be due to the older age of the patient. The epidemiology, risk factors, diagnosis, management and prognosis of iliac, ovarian and uterine vein thrombosis will be reviewed here, with emphasis on the relation to pregnancy.

About the Author

S. Schulman
McMaster University; Sechenov University
Russian Federation

Sam Schulman – MD, Dr Sci Med, Professor, Department of Medicine, Thrombosis and Atherosclerosis Research Institute, McMaster University; Department of Obstetrics and Gynecology, Filatov Clinical Institute of Children’s Health, Sechenov University

1280 Main Street West, Hamilton, Ontario L8S 4K1,

2 bldg. 4, Bolshaya Pirogovskaya Str., Moscow 119991


1. James A.H., Tapson V.F., Goldhaber S.Z. Thrombosis during pregnancy and the postpartum period. Am J Obstet Gynecol. 2005;193(1):216–9.

2. Goldhaber S.Z., Tapson V.F. A prospective registry of 5,451 patients with ultrasound-confirmed deep vein thrombosis. Am J Cardiol. 2004;93(2):259–62.

3. Khalil H., Avruch L., Olivier A. et al. The natural history of pelvic vein thrombosis on magnetic resonance venography after vaginal delivery. Am J Obstet Gynecol. 2012;206(4):356.e1–4.

4. James A.H. The natural history of pelvic vein thrombosis: the natural history of involution? Am J Obstet Gynecol. 2012;206(40:276–7.

5. May R., Thurner J. The cause of the predominantly sinistral occurrence of thrombosis of the pelvic veins. Angiology. 1957;8(5):419–27.

6. Kibbe M.R., Ujiki M., Goodwin A.L. et al. Iliac vein compression in an asymptomatic patient population. J Vasc Surg. 2004;39(5):937–43.

7. Fernández R.O., Rodríguez F.B., Acosta F.D., Barrios I.G. May-Thurner syndrome and surgery for scoliosis. Radiologia. 2008;50(3):245–7. [Article in Spanish].

8. Moudgill N., Hager E., Gonsalves C. et al. May-Thurner syndrome: case report and review of the literature involving modern endovascular therapy. Vascular. 2009;17(6):330–5.

9. Mousa A.Y., AbuRahma A.F. May-Thurner syndrome: update and review. Ann Vasc Surg. 2013;27(7):984–95.

10. Mei J.Y., Deshmukh U., Negi M. et al. May-Thurner syndrome in pregnancy: a multi-institutional case series and review of the literature. Am J Obstet Gynecol MFM. 2020;2(4):100240.

11. Messina L.M., Sarpa M.S., Smith M.A., Greenfield L.J. Clinical significance of routine imaging of iliac and calf veins by color flow duplex scanning in patients suspected of having acute lower extremity deep venous thrombosis. Surgery. 1993;114(5):921–7.

12. Baka J.J., Lev-Toaff A.S., Friedman A.C. et al. Ovarian vein thrombosis with atypical presentation: role of sonography and duplex Doppler. Obstet Gynecol. 1989;73(5 Pt 2):887–9.

13. Lenz C.J., Wysokinski W.E., Henkin S. et al. Ovarian vein thrombosis: incidence of recurrent venous thromboembolism and survival. Obstet Gynecol. 2017;130(5):1127–35.

14. Wouterlood M.A., Malhamé I., Lévesque K. et al. Pregnancy-associated pelvic vein thrombosis: Insights from a multicenter case series. J Thromb Haemost. 2020;19(8):1926–31.

15. Brown C.E., Stettler R.W., Twickler D., Cunningham F.G. Puerperal septic pelvic thrombophlebitis: incidence and response to heparin therapy. Am J Obstet Gynecol. 1999;181(1):143–8.

16. Dunnihoo D.R., Gallaspy J.W., Wise R.B., Otterson W.N. Postpartum ovarian vein thrombophlebitis: a review. Obstet Gynecol Surv. 1991;46(7):415–27.

17. Salomon O., Dulitzky M., Apter S. New observations in postpartum ovarian vein thrombosis: experience of single center. Blood Coagul Fibrinolysis. 2010;21(1):16–9.

18. Riva N., Calleja-Agius J. Ovarian vein thrombosis: a narrative review. Hamostaseologie. 2021;41(4):257–66.

19. Rottenstreich A., Da'as N., Kleinstern G. et al. Pregnancy and non-pregnancy related ovarian vein thrombosis: Clinical course and outcome. Thromb Res. 2016;146:84–8.

20. Twickler D.M., Setiawan A.T., Evans R.S. et al. Imaging of puerperal septic thrombophlebitis: prospective comparison of MR imaging, CT, and sonography. AJR Am J Roentgenol. 1997;169(4):1039–43.

21. Miller C.J. Ligation or excision of the pelvic veins in the treatment of puerperal pyaemia. Surg Gynecol Obstet. 1917;25:431.

22. Hoh J.K., Lee W.M., Lee H.J., Hwang J.H. Misdiagnosis of a large uterine vein thrombosis as a uterine myoma prior to hysterectomy: a case report. Ann Acad Med Singap. 2013;42(2):88–90.

23. Amin T., Cohen H., Wong M. et al. The prevalence of incidental uterine venous plexus thrombosis in women attending a gynecology clinic. J Thromb Haemost. 2020;18(10):2557–65.

24. Douketis J.D., Hutchison R., Patel V., Ginsberg J.S. Uterine vein thrombosis: an unusual variant of pelvic vein thrombophlebitis. J Obstet Gynaecol. 1997;17(1):106–7.

25. Leibovitz Z., Degani S., Shapiro I. et al. Diagnosis of pregnancy-associated uterine venous plexus thrombosis on the basis of transvaginal sonography. J Ultrasound Med. 2003;22(3):287–93.

26. Mavrelos D., Cohen H., Pateman K. et al. Diagnosis of uterine vein thrombosis on transvaginal ultrasound. Ultrasound Obstet Gynecol. 2013;42(4):480–3.

27. Chan W.S., Rey E., Kent N.E. et al. Venous thromboembolism and antithrombotic therapy in pregnancy. J Obstet Gynaecol Can. 2014;36(6):527–53.

For citation:

Schulman S. Pregnancy-related pelvic vein thrombosis. Obstetrics, Gynecology and Reproduction. 2021;15(5):627-632.

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