BACKGROUND AND PURPOSE: 

• Septic pelvic thrombophlebitis (SPT) is rare but serious condition  
  • Occurs in 1:500 to 2,000 cesarean deliveries and 1:9,000 vaginal deliveries 
  • Diagnosis of exclusion  
    • Abdominal or pelvic pain  
    • Patient remains febrile postpartum despite 3 to 4 days of antibiotics for presumptive endometritis 
• Dotters-Katz et al. (American Journal of Perinatology, 2017) performed a secondary analysis to determine risk factors for SPT 

METHODS: 

• Secondary case-control study of 73,087 women 
• Eunice Kennedy Shriver NICHD MFMU cesarean section registry (1999-2002) 
  • VBAC or cesarean section  
  • Delivery > 23 weeks  
  • SPT diagnosis was based on (1) suspected infectious thrombosis of the pelvic veins and/or (2) persistent febrile illness despite appropriate treatment  
  • Initial study did not require imaging for diagnostic confirmation   

RESULTS: 

• 0.12% developed SPT 
• 98% occurred after cesarean section  
• Risk factors for SPT when adjusted for co-founders: 
  • Cesarean section: adjusted odds ratio (aOR): 6.25 (95% CI 1.94–20.1; P=0.002)  
  • Chorioamnionitis: aOR 4.8 (95% CI: 2.95–7.86; P < 0.001) 
  • Non-Hispanic black race: aOR 2.60 (95% CI 1.68-4.02; p<0.001) 
  • Maternal age < 20 years: aOR 1.96 (95% CI 1.22-3.14; P=0.006)  
  • Hypertensive disorders of pregnancy: aOR 2.91 (95% CI 1.86-4.57; P <0.001) 
    • Chronic hypertension not associated  
  • Multiple gestation: aOR 2.10 (95% CI 1.13-3.88; P = 0.019 
  • Public insurance: aOR 1.98 (95% CI 1.28-3.04; P=0.002) 
• Pregestational diabetes was not a risk factor  
• Wound complications, DVT and PE were more common (P < 0.001) 

CONCLUSION: 

• New risk factors identified in this study include age < 20 years, non-Hispanic black race and multiple gestation 
• Probably multiple risk factors required to develop SPT 

Learn More – Primary Sources:  

Risk Factors for Postpartum Septic Pelvic Thrombophlebitis: A Multicenter Cohort

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ASPRE Trial: A Combined Risk Algorithm and Use of Aspirin to Prevent Preterm Preeclampsia

Chorioamnionitis: ACOG Committee Opinion on Diagnosis and Management

When to Stop Anticoagulation Following a DVT or Pulmonary Embolus?