Overview

Septic pelvic thrombophlebitis (SPT) may be a postpartum complication which consists of a persistent postpartum fever that's not aware of broad-spectrum antibiotics during which pelvic infection results in infection of the vein wall and intimal damage resulting in thrombogenesis within the ovarian veins (left or right, although right is more common thanks to dextroversion of the uterus). The thrombus is then invaded by microorganisms. Ascending infections cause 99% of postpartum SPT.

Septic pelvis thrombophlembitis is a cause of post-operative fever from untreated postpartum endometritis. After 48 hours of uncured postpartum endometritis (notably 48 hours of fever that is unaffected by antibiotics), one could diagnose SPT until proven otherwise (with pelvic radiography). Imaging studies can be helpful in patient refractory to broad-spectrum parenteral antibiotics to look for an abscess, retained products, or septic pelvic thrombophlebitis.

Septic pelvic thrombophlembitis (SPT) occurs most frequently in bedridden patients after parturition, or after having undergone a cesarean delivery. The blood often pools within the pelvis as this is often rock bottom a part of the patient while lying during a single bed.

Risk factors

The main risk factor of developing SPT is post-partum endometritis, which in turn is most commonly caused by a Caesarean section. Other risk factors for developing endometritis, and subsequently SPT include:

Ø  Bacterial vaginosis

Ø  Manual removal of the placenta

Ø  Prolonged labor

Ø  Large amount of meconium in amniotic fluid

Ø  Multiple cervical examinations

Symptoms

The symptoms of septic pelvic thrombophlebitis are almost like those of endometritis. Clinical signs include:

Ø  Fever

Ø  pain on palpation of uterus

Ø  midline lower abdominal pain

Ø  malodorous lochia (vaginal discharge)

Ø  tachycardia

Diagnosis

Since septic pelvic thrombophlebitis is a diagnosis of exclusion, other causes of postpartum fever must be considered, such as infection of cesarean section wounds, episiotomy or laceration sites as well as endometritis, endomyometritis, mastitis, and physiologic breast engorgement.

Treatment

With low uterine size retention, treat endometritis and SPT with ice packs, broad-spectrum antibiotics and analgesics.

With high uterine size retention, treat the thrombophlebitis with D&C aspiration under ultrasonogram because of increased risk of placental tissue retention in the myometrium.

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