Pulmonary embolism caused by ovarian vein thrombosis during cesarean section: a case report

Abstract

BackgroundOvarian vein thrombosis is a rare complication of pregnancy. The representative complaints of patients with ovarian vein thrombosis are abdominal pain and fever. In some cases, however, fatal pulmonary embolism may develop. We report a case of pulmonary embolism presenting with severe hypotension and loss of consciousness during cesarean section possibly caused by ovarian vein thrombosis.Case presentationA 25-year-old woman at 38 weeks 4 days of gestation was scheduled for repeat cesarean section. Her past history was unremarkable, and the progress of her pregnancy was uneventful. She did not experience any symptoms indicative of deep vein thrombosis. Cesarean section was performed under spinal anesthesia, and a healthy newborn was delivered. After removal of the placenta, she suddenly developed dyspnea, hypotension, and loss of consciousness with decreased peripheral oxygen saturation. Blood pressure, heart rate, and oxygen saturation recovered after tracheal intubation and mechanical ventilation with oxygen. Postoperative computed tomography revealed no abnormality in the brain or in the pulmonary artery, but a dilated right ovarian vein with thrombi, extending up to the inferior vena cava, was found. A diagnosis of pulmonary embolism caused by ovarian vein thrombosis was made, and heparin was administered. The tracheal tube was removed on the first postoperative day. Her postoperative course was uneventful, and she was discharged with no complications.ConclusionFatal pulmonary embolism might be caused by ovarian vein thrombosis during cesarean section. Careful and continuous observation of the patient after delivery and prompt treatment are important.

Left Ovarian Vein Thrombosis Presenting as Acute Postpartum Pyelonephritis

“…Clinical symptoms are vague and not very specific but most common presentation is in the puerperal period with fever and abdominal pain. However fatal pulmonary embolism has been reported in literature during cesarean section [8]. We report a rare case of ovarian vein thrombosis with presenting symptoms similar to acute left pyelonephritis four days after a spontaneous vaginal delivery of a preterm birth.…”

Ovarian Vein Thrombosis Complicated by Pulmonary Embolism after Cesarean Delivery in the Presence of a Large Fibroid: Case Report and Literature Review of Contributing Factors

“…Pulmonary emboli complicate less than 3% of OVT cases [ 15 ]. Emboli tend to be very small and rarely cause hypoxia, which may explain the absence of findings on the CT despite having high suspicion on clinical and indirect findings [ 16 ].…”

Pulmonary embolism caused by postpartum ovarian vein thrombophlebitis after vaginal delivery: Case report and brief review of the literature

“…PE is the main cause of maternal mortality. The incidence of PE increases during pregnancy and reaches its highest incidence after delivery . However, little information is available about inferior vena cava mural thrombosis and PE caused by POVT.…”