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      Septic Pelvic Thrombophlebitis: Diagnosis and Management

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          Abstract

          Septic pelvic thrombophlebitis (SPT) was initially diagnosed and described in the late 1800's. The entity had a high incidence and mortality during this period of time, and a surgical therapeutic approach was the treatment of choice. Since then, the diagnosis, incidence, and management of the entity evolved. This evolution followed the development of newer diagnostic tools such as computed tomography (CT), magnetic resonance imaging (MRI), and a better understanding of the pathophysiology of the disease. The treatment of SPT has had significant changes as well, from a surgical approach at the end of the 19th century to a medical approach after the 1960's. By using an adequate broad-spectrum antibiotic therapy, mortality has decreased. However, controversy in the management of this entity remains even till today.

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          Puerperal septic pelvic thrombophlebitis: incidence and response to heparin therapy.

          Charles Brown, R.William Stettler, Diane Twickler … (1999)
          Before the availability of modern imaging studies the diagnosis of septic pelvic thrombophlebitis causing prolonged puerperal fever was difficult to confirm without surgical exploration. With the use of computed tomography infection-related pelvic phlebitis can now be confirmed, and this study was designed to determine its incidence after delivery. We also designed a randomized clinical trial to evaluate the efficacy of heparin added to antimicrobial therapy for treatment of women with septic phlebitis. We studied women who had pelvic infection and fever that persisted after 5 days despite adequate antimicrobial therapy with clindamycin, gentamicin, and ampicillin. After giving consent study participants underwent abdominopelvic computed tomographic imaging. Women with pelvic thrombophlebitis were randomly assigned to 1 of 2 management schemes that included continuation of antimicrobial therapy, either alone or with the addition of heparin, until the temperature was .5). The 54 women with persistent fever but without computed tomographic evidence of septic pelvic thrombophlebitis were hospitalized for a mean of 12.0 +/- 4.1 days, compared with 10.9 +/- 2.9 days for women in whom thrombosis was diagnosed (P =.14). These women were followed up for >/=3 months post partum and none showed evidence of reinfection, embolic episodes, or postphlebitic syndrome. The overall incidence of septic pelvic thrombophlebitis was 1:3000 deliveries. The incidence was about 1:9000 after vaginal delivery and 1:800 after cesarean section. Women given heparin in addition to antimicrobial therapy for septic thrombophlebitis did not have better outcomes than did those for whom antimicrobial therapy alone was continued. These results also do not support the common empiric practice of heparin treatment for women with persistent postpartum infection.
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            Postpartum ovarian vein thrombosis after vaginal delivery: a report of 11 cases.

            A Witlin, B Sibai (1995)
            To review and characterize the presentation of postpartum ovarian vein thrombosis after vaginal delivery. We reviewed medical records of patients with the prior diagnosis of septic pelvic thrombophlebitis, deep vein thrombosis, and pulmonary embolism associated with pregnancy. The study covered the 10-year period from July 1984 through August 1994 and included women hospitalized at E.H. Crump Women's Hospital, Regional Medical Center, University of Tennessee, Memphis, Tennessee. During the study period, there were 76,858 deliveries: 13,109 cesareans and 63,749 vaginal deliveries. Eleven patients had documented postpartum ovarian vein thrombosis after vaginal delivery. Ten patients were readmitted an average of 7.6 days after delivery (range 3-17). The diagnosis was documented by computed tomography (CT) scan or ultrasound in ten women and laparotomy in one. Nine patients were readmitted with the presumptive diagnosis of endometritis, the other two with the presumptive diagnosis of pyelonephritis. Nine were treated initially with ampicillin, gentamicin, and clindamycin. Heparin therapy was added when failure of clinical response was noted. No patient defervesced within 24 hours of beginning heparin therapy; only two patients defervesced within 48 hours, and the remaining patients became afebrile at an average of 6.8 days (range 4-18, median 5). The diagnosis of ovarian vein thrombosis should be considered early in the care of patients readmitted with a diagnosis of endometritis after vaginal delivery. If prompt defervescence does not occur with aggressive intravenous antibiotic therapy, a CT scan should be obtained in a timely manner for prompt diagnosis and therapy. Our findings do not support the time-honored rule that septic pelvic thrombophlebitis and ovarian vein thrombosis respond within 24-48 hours to therapeutic anticoagulation with heparin.
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              Heparin therapy in septic pelvic thrombophlebitis: a study of 46 cases.

              William E Josey, R J STAGGERS (1974)
              Article 0 comments Cited 8 times – based on 0 reviews     Review now
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                Author and article information

                Journal
                Journal ID (nlm-ta): Infect Dis Obstet Gynecol
                Journal ID (publisher-id): IDOG
                Title: Infectious Diseases in Obstetrics and Gynecology
                Publisher: Hindawi Publishing Corporation
                ISSN (Print): 1064-7449
                ISSN (Electronic): 1098-0997
                Publication date (Print): 2006
                Publication date (Electronic): 4 July 2006
                Volume: 2006
                Electronic Location Identifier: 15614
                Affiliations
                Obstetrics, gynecology, and Women's Health Department, New Jersey Medical School, University of Medicine and Dentistry of New Jersey, Newark, NJ 07103, USA
                Author notes
                Article
                DOI: 10.1155/IDOG/2006/15614
                PMC ID: 1581461
                PubMed ID: 17485796
                SO-VID: 036a6153-90d4-4acd-84ef-cd0bec16f199
                Copyright © Copyright © 2006 Javier Garcia et al.
                License:

                This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                Date received : 9 March 2006
                Date revision received : 19 May 2006
                Date accepted : 5 June 2006
                Categories
                Subject: Clinical Study

                ScienceOpen disciplines: Obstetrics & Gynecology
                Data availability:
                ScienceOpen disciplines: Obstetrics & Gynecology

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