Journal of Clinical Case Reports and Images

Journal of Clinical Case Reports and Images

Current Issue Volume No: 2 Issue No: 2

Case-report Article Open Access
  • Available online freely Peer Reviewed

  • Postpartum Ovarian Vein Thrombosis After Coronavirus Disease

    EKMEZ Murat 1
        EKMEZ Fırat 2     DANE Cem 3    

    1 Sultangazi Haseki Training and Research Hospital, Department of Gynecology and Obstetrics, Istanbul, Turkey 

    2 Private Dr. Silopi/Şırnak-Turkey 

    3 İstinye University, Faculty of Medicine, Department of Gynecology and Obstetrics, Istanbul-Turkey 

    Abstract

    COVID-19 epidemic, described as a community health emergency by the World Health Organization, began in December 2019. COVID-19 is a source of deep vein thrombosis (DVT) because of hypercoagulation, blood stasis, and endothelium injury complications. This study reports a 26-year-old pregnant woman with coronavirus hospitalized with a left ovarian vein (LOV) thrombosis at Sultangazi- Haseki Training and Research Hospital in Istanbul. Risk classification for DVT disease is of crucial importance for the forecast of coronavirus.
    Author Contributions
    Received Sep 15, 2021     Accepted Dec 29, 2021     Published Jan 04, 2022

    Copyright© 2022 EKMEZ Murat, et al.
    License
    Creative Commons License   This work is licensed under a Creative Commons Attribution 4.0 International License. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

    Competing interests

    The authors have declared that no competing interests exist.

    Funding Interests:

    Citation:

    EKMEZ Murat, EKMEZ Fırat, DANE Cem (2022) Postpartum Ovarian Vein Thrombosis After Coronavirus Disease Journal of Clinical Case Reports and Images. - 2(2):15-19
    DOI 10.14302/issn.2641-5518.jcci-21-3959

    Introduction

    Introduction

    In December 2019, the first case of COVID-19 pneumonia was reported in Wuhan, China’s Hubei Province, and the disease quickly spread to other parts of the world 12. The new coronavirus SARS-CoV-2 is the source of the novel coronavirus infection COVID-19. An excessive inflammatory response is the characteristic feature of the virus. It can lead to severe manifestations such as adult respiratory distress syndrome, septicemia, coagulopathy, and death in some patients 3. Ovarian vein thrombosis (OVT) is a rare thrombotic condition that primarily affects postpartum women; It is usually manifested by fever and lower abdominal pain that occurs weeks after birth 45.

    Patients with COVID-19 are in the high-risk group of thrombosis due to their hypercoagulation, blood stasis, and endothelium injury 6. OVT is a severe and uncommon disease that can occur anywhen. It is more common in the period after childbirth than in other cases, and its frequency is about 1 in 2000–3000 labors 5. More than 80% of the after-childbirth thrombosis cases are in the right gonadal vein 7. Clinical symptoms such as abdominal pain, pyrexia, nausea, vomiting, and malaise are some of the symptoms of this type of thrombosis.

    OVT is a condition that occurs in 0.02%–0.18% of pregnancies, and 80%–90% of it can be identified on the right side of the affected cases 456. Characteristic visualization findings on ultrasonography involve tubular, hypoechoic adnexal, and/or iliac fossa masses. MRI allowed imaging of the overall track of the ovarian veins in patients with an inconsequential CT scan or ultrasonography, offering improved sensitiveness and specificity (92% to 100% and 100%, respectively 7.

    In that case, we delivered a live baby at the 39th week of a pregnant woman who had a Covid-19 infection at her 30th week of pregnancy. In light of the current literature, we treated the patient diagnosed with ovarian vein thrombosis after presenting with abdominal pain on the 10th postoperative day.

    Discussion

    Discussion

    OVT ensues in about 1 in 600 to 1 in 2000 pregnancies. It shows signs of as a triad of pain, fever, and abdominal mass 2. It is hypothecated that OVT generally occurs on the right side because the right ovarian vein (ROV) is longer than the LOV, and it lacks competency of the valves 2. The ROV enters the inferior vena cava at an acute angle, making it more susceptible to compression 4.

    In our case, we found LOV thrombosis contrary to what is usually detected. This situation could be an indication of the low incidence of our case.

    In terms of pathophysiology, many cases have demonstrated that patients with COVID-19 are generally vulnerable to lack of water to venous thrombosis due to pyrexia and diarrhea, hypotension, secondary infections, and extended rest cure. So, to decrease the complications and fatality rate from COVID-19, it is essential to value the risk of DVT.

    It is worthy of mention that it is not seen any evidence of venous thrombosis in previous deliveries when the patient s medical history was examined before COVID-19, and there were no recordings of the disease in the patient s family. Therefore, it is considered that acute thrombosis like this occurred during the COVID-19 infection.

    Our report attaches further documents on side reactions such as blockade of veins and arteries in a patient with COVID-19. Assessment and risk classification for DVT disease are critical for the prognosis of coronavirus disease.

    The preliminary coagulopathy of COVID-19 shows a featured ascent of D-dimer and fibrin and fibrinogen-degradation products, whereas abnormalities in PT, PTT, and platelet counts are comparatively uncommon at first view. Clotting test screening, including evaluating D-dimer and fibrinogen levels, is recommended 8.

    The most characteristic indication in patients with COVID-19 and coagulopathy is an heighten D-dimer concentration, a relatively moderate decrease in platelet count, and a extension of the PT 10.

    Many patients with exquisite COVID-19 present with coagulation abnormalities that trigger other systemic coagulopathies associated with serious infections, such disseminated intravascular coagulation or thrombotic microangiopathies, but coronavirus has evident features 9.

    Besides, OVT mainly occurs in the puerperium period due to postpartum endometritis and concomitant flow changes in the venous system (Hodgkinson CP, 1953).

    Complications of symptomatic OVT comprise sepsis and thrombus extension (25% to 30%) to the inferior vena cava or left renal vein or rarely pulmonary embolism.

    Asymptomatic OVT is more common and may be benign, with a 30% incidence of pelvic (iliac and ovarian) vein thrombosis stated on screening MRI after vaginal delivery 5. pyrexia was not accompanied in our case; blood culture was not studied.

    The fact that the patient did not take any antiviral treatment when she had a COVID-19 infection at 30 weeks old, may have caused to the OVT that happened in the postoperative period. Perhaps, for this reason, the tendency to coagulation during pregnancy may have caused this rare condition to occur.

    The patient was not in danger of having a DVT, and she had no history of vein thrombosis in both previous pregnancies and the postpartum period. Contrary to expectations, vein thrombosis in the LOV is observed instead of the ROV in the patient. Considering this situation, having a COVID-19 infection during pregnancy should be regarded as a risk factor for deep vein thrombosis.

    Affiliations:
    Affiliations: