Septic pelvic thrombophlebitis

Divided into two categories: ovarian vein thrombophlebitis and deep septic pelvic thrombophlebitis.

The above entities present with fever and abdominal pain about one week following vaginal or surgical delivery.

Refers to 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.

The thrombus is then invaded by microorganisms.

Ascending infections cause 99% of postpartum cases.

Can be a cause of post-operative fever from untreated postpartum endometritis.

After 48 hours of postpartum endometritis associated with fever unaffected by antibiotics the diagnosis is suggested.

Imaging studies are done to, look for an abscess, retained products, or septic pelvic thrombophlebitis.

Occurs most often in bedridden patients after giving birth, or after having undergone a Caesarean section.

Blood often pools in the pelvis as this is the lowest part of the patient while laying in a hospital bed.

The main risk factor of developing SPT is post-partum endometritis.

It is most commonly caused by a Caesarean section.

Other risk factors for developing endometritis, and subsequently SPT include:

Bacterial vaginosis

Manual removal of the placenta

Prolonged labor

Large amount of meconium in amniotic fluid

Multiple cervical examinations

The symptoms of septic pelvic thrombophlembitis include:


pain on palpation of uterus

midline lower abdominal pain

vaginal discharge


Elevated CRP and WBC

A diagnosis of exclusion.

Other causes of postpartum fever must be considered: infection of cesarean section wounds, episiotomy or laceration sites as well as endometritis, endomyometritis, mastitis, and physiologic breast engorgement.

With low uterine size retention, treat endometritis and use 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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