Septic pelvic thrombophlebitis
- Katherine T Chen, MD, MPH
Katherine T Chen, MD, MPH
- Professor of Obstetrics, Gynecology, and Reproductive Science
- Icahn School of Medicine at Mount Sinai
- Section Editors
- Daniel J Sexton, MD
Daniel J Sexton, MD
- Editor-in-Chief — Infectious Diseases
- Section Editor — Bacterial Infections
- Professor of Medicine
- Duke University Medical Center
- Charles J Lockwood, MD, MHCM
Charles J Lockwood, MD, MHCM
- Section Editor — Obstetrics
- Senior Vice President, USF Health
- Dean, Morsani College of Medicine
- Professor, Obstetrics and Gynecology
- University of South Florida
Septic pelvic thrombophlebitis (SPT) can occur in the setting of pelvic vein endothelial damage, venous stasis, and hypercoagulability. It is usually associated with postpartum parametritis following cesarean deliveries in the setting of chorioamnionitis but can also occur with other conditions, such as pelvic surgery or underlying malignancy. SPT was first described in the late 1800s by Von Recklinghausen  and was further elucidated in the 1950s by a series of reports describing a cohort of 70 women who had fever following obstetric or gynecologic procedures and had grossly palpable intravenous thrombi and seropurulent fluid in the pelvis on exploratory laparotomy [2-5]. Surgical excision or ligation of the thrombosed vein was the initial treatment of choice, although medical therapy has since become the preferred approach.
The clinical manifestations, diagnosis, and treatment of septic pelvic thrombophlebitis are discussed here. Suppurative thrombophlebitis of other veins is discussed elsewhere. (See "Suppurative (septic) thrombophlebitis" and "Pylephlebitis" and "Septic dural sinus thrombosis".)
Incidence — Septic pelvic thrombophlebitis (SPT) is a rare complication of pregnancy. One survey in the United States suggested that the incidence of SPT was 1 in 3000 deliveries (1 in 9000 vaginal deliveries and 1 in 800 cesarean deliveries) . Similarly, in one study of over 73,000 women who underwent cesarean delivery or vaginal delivery after prior cesarean, only 89 (0.1 percent) had suspected or documented SPT .
Risk factors — SPT is largely a disease of postpartum women. The risk is higher with cesarean compared with vaginal delivery. Women with peripartum or postpartum pelvic infections, such as endometritis or chorioamnionitis, are also at higher risk for SPT. As an example, in one case control study of over 73,000 women in a pregnancy registry, cesarean delivery and chorioamnionitis were each independently associated with SPT (adjusted odds ratios 6.3 and 4.8, respectively) .
Other pregnancy-related risk factors include [4,7-14]:To continue reading this article, you must log in with your personal, hospital, or group practice subscription. For more information on subscription options, click below on the option that best describes you:
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- Risk factors
- CLINICAL FEATURES
- DIAGNOSTIC APPROACH
- Initial evaluation
- Establishing the diagnosis
- Evaluation for hypercoagulability
- DIFFERENTIAL DIAGNOSIS
- Site of care
- SUMMARY AND RECOMMENDATIONS