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Ovarian Vein ThrombosisFrom: dahmd@gate.netThu Apr 4 16:53:18 1996
My partners and I have an interesting case and would appreciate input from list members: A 30 year old underwent a successful vaginal birth after cesarean (1 prior low transverse c/section without extensions) via vacuum for arrest of descent at +2 station, and had a sidewall laceration that was sewn without difficulty. She was discharged uneventfully 2 days later, but returned 3 days after that with worsening right lower quadrant pain. Differential diagnosis initially was hematoma from uterine scar separation, versus retroperitoneal hematoma from sidewall laceration. Vaginal ultrasound revealed probable right broad ligament hematoma. Due to flank pain I ordered an IVP, which was normal. Physical was negative for mass in sidewall, rectovaginal space, or elsewhere. Her temp was 103 degrees F, but she appeared well. White blood cell count was 9,000,and hemaglobin was 11.0. Fever did not abate with antibiotics, and reevaluation by CT (after unsuccesful CT-guided drainage for presumed abscess) revealed a probable 5cm right ovarian vein thrombus. She has responded extrememly well to heparin (i.e. temp dropped 20 minutes after start of heparin)! The question: Since this is a large thrombus, would you convert heparin to coumadin, and if so, for how long? My take on the literature is that nobody has data (one way or the other) to support coumadin at all. However, this is one large clot. Thanks in advance, Ashley D. Ashley Hill, M.D. dahmd@gate.net Orlando, FL
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