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Am J Perinatol 2017; 34(11): 1148-1151
DOI: 10.1055/s-0037-1604245
Original Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Risk Factors for Postpartum Septic Pelvic Thrombophlebitis: A Multicenter Cohort

Sarah K. Dotters-Katz
1   Division of Maternal-Fetal Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
,
Marcela C. Smid
2   Division of Maternal-Fetal Medicine, University of Utah, Salt Lake City, Utah
,
Matthew R. Grace
1   Division of Maternal-Fetal Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
,
Jennifer L. Thompson
3   Division of Maternal-Fetal Medicine, Vanderbilt University, Nashville, Tennessee
,
R. Phillips Heine
4   Division of Maternal-Fetal Medicine, Duke University, Durham, North Carolina
,
Tracy Manuck
1   Division of Maternal-Fetal Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
› Author Affiliations
Further Information

Publication History

03 April 2017

12 June 2017

Publication Date:
13 July 2017 (online)

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Abstract

Objective The objective of this study was to identify risk factors associated with the development of septic pelvic thrombophlebitis (SPT).

Study Design This is a secondary case–control study of the Eunice Kennedy Shriver National Institute of Child Health and Human Development Maternal-Fetal Medicine Unit Network Cesarean Registry. SPT was defined as suspected infectious thrombosis of the pelvic veins, often persistent febrile illness in the setting of antibiotic therapy for endometritis. Women with SPT were compared with those without SPT using descriptive statistics. Logistic regression models estimated the association between selected risk factors and SPT.

Results Of 73,087 women in the cohort, 89 (0.1%) developed SPT. Women with SPT were more likely to be < 20 years old (33.7 vs. 10.6%, p < 0.001), black race (58.4 vs. 29.1%, p < 0.001), and nulliparous (51.1 vs. 23.3%, p < 0.001). Hypertensive disorders of pregnancy (32.6 vs. 11.8%, p < 0.001) and multiple gestation (12.5 vs. 7.4%, p = 0.03) were also more common in women with SPT. In the multivariable regression model, maternal age < 20, black race, multiple gestation, and preeclampsia were all significantly associated with increased odds of SPT (adjusted odds ratio [aOR]: 1.96, 95% confidence interval [CI]: 1.22, 3.14; aOR: 2.6, 95% CI: 1.68, 4.02; aOR: 2.10, 95% CI: 1.13, 3.88; aOR: 2.91, 95% CI: 1.86, 4.57).

Conclusion SPT is a rare pregnancy complication. Our analysis confirmed known risk factors (e.g., infections, cesarean delivery), and identified novel ones, including black race, young age, preeclampsia, and multiple gestation.

Keywords

septic pelvic thrombophlebitis - maternal - morbidities - postpartum fever - postpartum - infection

Note

This article was presented in part at the 37th Annual Society of Maternal Fetal Medicine Meeting in 2017, Las Vegas, Nevada as a poster presentation.


Funding

None.


 

  • References

  • 1 Brown CE, Stettler RW, Twickler D, Cunningham FG. Puerperal septic pelvic thrombophlebitis: incidence and response to heparin therapy. Am J Obstet Gynecol 1999; 181 (01) 143-148
    CrossrefPubMedGoogle Scholar
  • 2 Duff P, Gibbs RS. Pelvic vein thrombophlebitis: diagnostic dilemma and therapeutic challenge. Obstet Gynecol Surv 1983; 38 (06) 365-373
    CrossrefPubMedGoogle Scholar
  • 3 Dunnihoo DR, Gallaspy JW, Wise RB, Otterson WN. Postpartum ovarian vein thrombophlebitis: a review. Obstet Gynecol Surv 1991; 46 (07) 415-427
    CrossrefPubMedGoogle Scholar
  • 4 Collins CG. Suppurative pelvic thrombophlebitis. A study of 202 cases in which the disease was treated by ligation of the vena cava and ovarian vein. Am J Obstet Gynecol 1970; 108 (05) 681-687
    CrossrefPubMedGoogle Scholar
  • 5 Collins CG, MacCALLUM EA, Nelson EW, Weinstein BB, Collins JH. Suppurative pelvic thrombophlebitis. I. Incidence, pathology, and etiology; a study of 70 patients treated by ligation of the inferior vena cava and ovarian vessels. Surgery 1951; 30 (02) 298-310
    PubMedGoogle Scholar
  • 6 Witlin AG, Sibai BM. Postpartum ovarian vein thrombosis after vaginal delivery: a report of 11 cases. Obstet Gynecol 1995; 85 (5 Pt 1): 775-780
    CrossrefPubMedGoogle Scholar
  • 7 Garcia J, Aboujaoude R, Apuzzio J, Alvarez JR. Septic pelvic thrombophlebitis: diagnosis and management. Infect Dis Obstet Gynecol 2006; 2006: 15614
    CrossrefPubMedGoogle Scholar
  • 8 Jaiyeoba O. Postoperative infections in obstetrics and gynecology. Clin Obstet Gynecol 2012; 55 (04) 904-913
    CrossrefPubMedGoogle Scholar
  • 9 Duff P. Septic Pelvic Vein Thrombophlebitis. St. Louis, MO: Mosby Year Book; 1993
    Google Scholar
  • 10 Gibbs RS, Jones PM, Wilder CJ. Antibiotic therapy of endometritis following cesarean section. Treatment successes and failures. Obstet Gynecol 1978; 52 (01) 31-37
    PubMedGoogle Scholar
  • 11 Landon MB. Predicting uterine rupture in women undergoing trial of labor after prior cesarean delivery. Semin Perinatol 2010; 34 (04) 267-271
    CrossrefPubMedGoogle Scholar
  • 12 Isler CM, Rinehart BK, Terrone DA, Crews JH, Magann EF, Martin Jr JN. Septic pelvic thrombophlebitis and preeclampsia are related disorders. Hypertens Pregnancy 2004; 23 (01) 121-127
    CrossrefPubMedGoogle Scholar
  • 13 Rouse DJ, Landon M, Leveno KJ. , et al; National Institute of Child Health And Human Development, Maternal-Fetal Medicine Units Network. The Maternal-Fetal Medicine Units cesarean registry: chorioamnionitis at term and its duration-relationship to outcomes. Am J Obstet Gynecol 2004; 191 (01) 211-216
    CrossrefPubMedGoogle Scholar
  • 14 Rath W. Pre-eclampsia and inherited thrombophilia: a reappraisal. Semin Thromb Hemost 2011; 37 (02) 118-124
    Article in Thieme ConnectPubMedGoogle Scholar
  • 15 Hauth J. MFMU cesarean registry: thromboembolism—occurrence and risk factors in 39,285 cesarean births. Am J Obstet Gynecol 2003; 189 (06) s120
    PubMedGoogle Scholar