Diagnosis of Pregnancy-Associated Uterine Venous Plexus Thrombosis on the Basis of Transvaginal Sonography

Abstract

Focusing on the pelvic veins while performing a transvaginal sonographic study during pregnancy may reveal important findings, which may have clinical implications. The therapeutic treatment of uterine venous plexus thrombosis is controversial and still empirical.

Diagnosis of uterine vein thrombosis on transvaginal ultrasound

“…Objective criteria of vein distension are yet to be defined, and there is no normal range for pelvic vein diameter. In the case series of Leibovitz et al , vein diameter ranged from 10 to 16 mm, whereas in our case series the range was 5–15 mm.…”

“…This is a relatively common mutation affecting 2–5% of Caucasian populations and is associated with a modest increase in the background risk of thrombosis. Our findings are discordant with those of Leibovitz et al because these authors reported no thrombophilic defects in any of their patients. However, they do not specify which tests were carried out.…”

“…In all women we were able to visualize single or multiple solid intraluminal lesions, which partially occluded the vessels on Doppler examination. The only published report that we have identified on the diagnosis of incidental pelvic vein thrombosis using transvaginal ultrasound was a case series by Leibovitz et al that included four pregnant women. They based their diagnosis on the visualization of dilated pelvic veins containing round echogenic structures within the lumen on transverse planes that transformed into elongated strips on longitudinal planes.…”

Cervical varices complicated by thrombosis in pregnancy

“…After multidisciplinary consultation, we decided that the risk of bleeding outweighed the benefits of anticoagulant therapy in a woman with no proven thrombophilia. A previous report by Leibovitz et al 8 described four cases of uterine venous plexus thrombosis that were diagnosed in the first trimester. These cases, however, were not associated with cervical varices carrying an increased risk of bleeding, which facilitated the decision to initiate anticoagulant therapy.…”

Round ligament varicosities associated with uterine varicosities in pregnancy: A case report

“…The basic management of RLVs during pregnancy is conservative because anesthesia and surgery may precipitate labor and RLVs will resolve spontaneously during the postpartum period because pelvic venous obstruction by the gravid uterus is relieved . However, close monitoring is critical because of the risk of rupture or acute thrombosis of the varices . In this case, breath‐holding was reduced to avoid increased intra abdominal pressure and a posterolateral episiotomy was performed to shorten second stage of labor and thereby reduce the risk of RLV rupture.…”