Risk factors associated with postpartum ovarian vein thrombosis

Thrombosis of the ovarian vein is a remarkable process occuring within a fe w days of labor in 1:500-1:2000 women. Its presentation is characterized by fever, abdominal pain and occasionally by a palpable abdominal mass that i n earlier years sometimes lead to explorative laparotomy. With the advent o f modern imaging techniques the diagnosis can be made relatively easily. Th e pathogenesis has been attributed to an infectious process expanding from the uterus to the right ovarian vein and stasis. A predisposition towards t hrombosis has not been so far explored. In this study we retrospectively an alysed the clinical features, diagnosis and treatment of 22 patients with o bjective documentation of post partum ovarian vein thrombosis (POVT) and as sessed potential risk factors. In 11 of the 22 patients (50%) inherited pro thrombotic risk factors were detected as follows: 4 were heterozygous for f actor V G1691A, 2 had protein S deficiency, one had protein S deficiency an d was heterozygous for factor V G1691A, and 4 were homozygous for MTHFR C67 7T. Eight of the 11 patients who bore a prothrombotic predisposition underw ent cesarean section. Taken together, the data suggest that POVT may result from the combined effect of an infection, cesarian section and a prothromb otic tendency.