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Semin Thromb Hemost
DOI: 10.1055/a-2651-7717
Review Article

From Puerperal Fever to Ovarian Vein Thrombosis: An Historical Journey and Contemporary Challenges in Diagnosis and Management

Elvira Grandone
1   Obstetrics and Gynecology Department, University of Foggia, Foggia, FG, Italy
2   Thrombosis and Haemostasis Unit, I.R.C.C.S. “Casa Sollievo della Sofferenza,” San Giovanni Rotondo, Foggia, Italy
3   Department of Obstetrics, Gynaecology and Perinatal Medicine, First I.M. Sechenov Moscow State Medical University, Moscow, Russia
,
Francesco Marongiu
4   Department of Medical Science and Public Health, University of Cagliari, Cagliari, Italy
5   Departmental Unit of Thrombosis and Haemostasis, Azienda Ospedaliero-Universitaria di Cagliari, Cagliari, Italy
,
Doris Barcellona
4   Department of Medical Science and Public Health, University of Cagliari, Cagliari, Italy
5   Departmental Unit of Thrombosis and Haemostasis, Azienda Ospedaliero-Universitaria di Cagliari, Cagliari, Italy
› Author Affiliations
Funding This research was in part funded by the Italian Ministry of Health, RC2024. It is also partially funded by the European Union under the Horizon Europe Innovation Action ThrombUS+ (grant agreement no. 101137227). The views and opinions expressed are solely those of the authors and do not necessarily represent those of the European Union or HADEA, the granting authority. Neither the European Union nor HADEA can be held responsible for these views.
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Abstract

Puerperal sepsis (PPS) is a severe postpartum infection that remains a significant maternal health concern. Recent evidence suggests a potential link between PPS and ovarian vein thrombosis (OVT), a rare but life-threatening complication occurring in 0.01 to 0.18% of pregnancies. Despite the historical significance of PPS and its well-documented consequences, its association with thrombosis remains underrecognized in obstetric practice. This narrative review explores the historical context, clinical presentation, diagnosis, and management of PPS and OVT while emphasizing the need for increased awareness and preventive strategies. Sepsis triggers a hypercoagulable state through inflammatory cytokine release, endothelial injury, and coagulation activation, contributing to thrombotic complications such as OVT. The right ovarian vein is more commonly affected due to anatomical factors, including uterine dextrorotation during pregnancy. OVT typically presents with abdominal pain and fever, requiring imaging modalities such as Doppler ultrasound and magnetic resonance imaging for diagnosis. Although anticoagulation therapy is widely used for deep vein thrombosis, its application in OVT remains inconsistent, despite comparable recurrence rates between the two conditions. The review also highlights the lack of consensus on thromboprophylaxis in septic postpartum patients. Although guidelines from major obstetric organizations are inconsistent, emerging evidence suggests that low-molecular-weight heparins may reduce thrombotic risk in PPS. In the absence of large-scale randomized trials, observational studies remain essential for guiding clinical decisions.

Keywords

puerperal infection - embolism and thrombosis - ovary

Authors' Contributions

F.M. and D.B. performed the research of literature review. All authors wrote the manuscript and critically revised the draft, and approved the final version.




Publication History

Received: 22 March 2025

Accepted: 09 July 2025

Accepted Manuscript online:
09 July 2025

Article published online:
29 July 2025

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