Septic pelvic thrombophlebitis
Septic pelvic thrombophlebitis (SPT) is a postpartum complication which consists of a persistent postpartum fever that is not responsive to broad-spectrum antibiotics in which pelvic infection leads to infection of the vein wall and intimal damage leading to thrombogenesis in the ovarian arteries (left or right). The thrombus is then invaded by microorganisms. Ascending infections cause 99% of postpartum SPT.
Septic pelvis thrombophlebitis is be a complication of 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 radiographs). Imaging studies can be helpful in patient refractory to broad-spectrum parenteral antibiotics to look for an abscess, retained products, or septic pelvic thrombophlebitis.[1]
Symptoms
The symptoms of septic pelvic thrombophlembitis are similar to those of endometritis. Clinical signs include:
- fever
- pain on palpation of uterus
- malodorous vaginal discharge
Laboratory results
Septic pelvic thrombophlebitis will have elevated CRP and WBC (evidence of inflammation).
Diagnosis
Since septic pelvic thrombophlebitis is a diagnosis of exclusion, other causes of postpartum fever must be considered, such as endometritis, endomyometritis, mastitis, and physiologic breast engorgement.[2]
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.