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Postpartum infections
Published in Hung N. Winn, Frank A. Chervenak, Roberto Romero, Clinical Maternal-Fetal Medicine Online, 2021
Pelvic thrombophlebitis encompasses two fairly distinct forms—ovarian vein thrombosis and thrombosis of multiple small pelvic vessels. In the acute ovarian vein syndrome, onset is usually within 2 to 4 days postoperatively, but may be weeks after delivery. The patient usually appears ill with a low-grade fever, tachycardia, flank or lower abdominal pain with guarding, and ileus with abdominal distention. Nausea and vomiting may be present. A tender, rope-like, abdominal mass originating near the uterine cornu and extending cephalad and laterally, palpable in one-half to two-thirds of patients, represents the thrombosed ovarian vein. Ovarian vein thrombosis commonly occurs in association with pelvic infection, but the patient’s symptoms worsen, rather than improve, with continued antibiotic therapy. The syndrome may present in the absence of clinical infection, sometimes prompting laparotomy to exclude other disorders. The differential diagnosis includes acute appendicitis, broad ligament hematoma, degenerating fibroid, adnexal torsion, pyelonephritis, ureterolithiasis, and abscess.
Practical guide for pelvic insufficiency scanning
Published in Joseph A. Zygmunt, Venous Ultrasound, 2020
The right ovarian vein is identified in a similar fashion to the left ovarian vein; however, the anatomy is slightly different. The right ovarian vein can be identified in its central segment just superior and to the right of the umbilicus as it confluences with the inferior vena cava. The peripheral segment can be identified in an identical fashion to the contralateral side utilizing the external iliac artery and vein and psoas muscle (Figure 7.15). The right ovarian vein should also be evaluated throughout its length with diameter measurements and color/pulsed wave Doppler as described for the left ovarian vein (Figure 7.16).
Thromboembolic Disease in the Obstetric Patient: Evaluation, Diagnosis, and Treatment
Published in Hau C. Kwaan, Meyer M. Samama, Clinical Thrombosis, 2019
Acute ovarian thrombosis has been reported to occur postpartum in 1/4000 deliveries.64 In contrast to SPT, ovarian vein thrombosis is characterized by severe pain localized to the involved adnexa (usually the right) 2 to 3 d postpartum. Fever is consistently present, and flank or abdominal pain may also be noted.64,65 A trial of therapeutic heparinization is indicated after ureteral obstruction has first been excluded by a pyleogram. Detectable by computerized tomography, the diagnosis of ovarian vein thrombosis is, in practice, usually made at laparotomy.66 Ligation is indicated if the clot extends into inferior vena cava. Heparin should be continued 10 to 15 d, but the value of long-term anticoagulation is unclear.
Long-term outcomes of patients with preeclampsia, a review of the literature
Published in Hypertension in Pregnancy, 2023
Alice Tassi, Alessia Sala, Ilaria Mazzera, Stefano Restaino, Giuseppe Vizzielli, Lorenza Driul
In a meta-analysis, Bellamy et al. (26) included three studies analyzing the link between preeclampsia and subsequent risk of thromboembolic events, in a total of 35,772 women and a median of 4.7 years of follow-up. Women who developed preeclampsia during pregnancy, had an increased risk [1.79 (1.37–2.33)] of vascular disease compared with women without a diagnosis of PE. A further distinction was made by Kestenbaum et al. (36). According to them, severe preeclampsia is associated with a higher risk of venous thromboembolism (2.3, 1.3–4.2) compared with moderate pre-eclampsia in years after delivery. Among thromboembolic complications, it is also important to keep in mind a less frequent but life-threatening event: the ovarian vein thrombosis. It occurs in 0.02–0.20% of all pregnancies and can be associated with HDP (37,38).
One-stage surgical removal of post-hysterectomy intravenous leiomyomatosis with inferior vena cava and heart extension using normothermic cardiopulmonary bypass
Published in Journal of Obstetrics and Gynaecology, 2021
Goran Vujić, Andrija Škopljanac Mačina, Mislav Mikuš, Željko Đurić, Ivo Pedišić, Ante Zvonimir Korda
After multidisciplinary consult of gynaecologic, cardiac and vascular surgeons, the patient underwent prompt surgical procedure. A median laparotomy was performed, as we opened retroperitoneal space and visualised myomatous formation around 6 cm invading right ovarian vein. Careful surgical dissection and resection of right ovarian vein was carried out. Subsequently, median sternotomy was performed and after heparinisation, normothermic cardiopulmonary bypass (CPB) was established between the ascending aorta, superior vena cava (SVC) and IVC at the point just above the iliac vein confluence. After snaring of the SVC cannula, LV fibrillation was induced and the right atriotomy was performed to prevent embolisation of the tumour mass. Then we performed 4 cm long incision in the IVC extending just below right ovarian vein directed cranially and placed vascular clamp on the left renal vein to mitigate bloodless surgical field. The smooth, firm white-colored tumour mass was gently grasped with resano forceps and completely extracted from within the IVC in one piece under direct vision from the RA (Figure 3). The length of the tumour from IVC to the RA was around 40 cm. The total operative time was 105 minutes, and intraoperatively patient received 250 mL of red blood cells. The postoperative period was unremarkable and the patient was discharged from hospital on the twelfth postoperative day. She was maintained on regular anticoagulant warfarin treatment to achieve an international normalised ratio of 2 to 3. Postoperative CTA revealed complete tumour resection 6 months after procedure.
Adnexal incidentalomas on multidetector CT: how to manage and characterise
Published in Journal of Obstetrics and Gynaecology, 2020
A. C. Tsili, M. I. Argyropoulou
Another helpful sign in recognising the ovary and differentiating ovarian from nonovarian masses relates to the course of the ovarian vein (Saksouk and Johnson 2004; Govil and Justus 2006). Tracking the ovarian vein from the level of the renal vessels along the anterior surface of the psoas major muscle caudally to the pelvis leads to the suspensory ligament region in the vicinity of the ovary and is often helpful in defining the origin of a pelvic mass. Govil and Justus (2006) in a retrospective study of 68 helical CT examinations reported that the ovarian veins were identified in 98% of women and their entire length was traced in 92% of cases. The “ovarian vascular pedicle” sign also has been reported as a sign suggesting the ovarian origin of a mass. Ovarian masses may cause enlargement of the ipsilateral ovarian vessels, therefore the detection of asymmetrically enlarged gonadal veins in a pelvic mass indicates the ovarian origin (Lee et al. 2003; Asayama et al. 2006).