Risk Factors for Postpartum Septic Pelvic Thrombophlebitis: A Multicenter Cohort
03 April 2017
12 June 2017
13 July 2017 (online)
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.
Keywordsseptic pelvic thrombophlebitis - maternal - morbidities - postpartum fever - postpartum - infection
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.
- 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
- 2 Duff P, Gibbs RS. Pelvic vein thrombophlebitis: diagnostic dilemma and therapeutic challenge. Obstet Gynecol Surv 1983; 38 (06) 365-373
- 3 Dunnihoo DR, Gallaspy JW, Wise RB, Otterson WN. Postpartum ovarian vein thrombophlebitis: a review. Obstet Gynecol Surv 1991; 46 (07) 415-427
- 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
- 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
- 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
- 7 Garcia J, Aboujaoude R, Apuzzio J, Alvarez JR. Septic pelvic thrombophlebitis: diagnosis and management. Infect Dis Obstet Gynecol 2006; 2006: 15614
- 8 Jaiyeoba O. Postoperative infections in obstetrics and gynecology. Clin Obstet Gynecol 2012; 55 (04) 904-913
- 9 Duff P. Septic Pelvic Vein Thrombophlebitis. St. Louis, MO: Mosby Year Book; 1993
- 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
- 11 Landon MB. Predicting uterine rupture in women undergoing trial of labor after prior cesarean delivery. Semin Perinatol 2010; 34 (04) 267-271
- 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
- 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
- 14 Rath W. Pre-eclampsia and inherited thrombophilia: a reappraisal. Semin Thromb Hemost 2011; 37 (02) 118-124
- 15 Hauth J. MFMU cesarean registry: thromboembolism—occurrence and risk factors in 39,285 cesarean births. Am J Obstet Gynecol 2003; 189 (06) s120