Table 1.
Summary of cases. All patients were managed with anticoagulation, aspirin, and compression stockings. All patients delivered at term, without obstetric complications; however, one patient developed a postpartum gonadal vein thrombosis after missing a dose of her anticoagulant. Abbreviations: GP: gravidity parity, GA: gestational age, DVT: deep venous thrombosis, LCFV: left common femoral vein, LCIV: left common iliac vein, IVC: inferior vena cava, MTS: May Thurner Syndrome, UFH: unfractionated heparin, CDT: catheter-directed thrombolysis, LSFV: left superficial femoral vein, LMWH: low molecular weight heparin, PP: postpartum, ASA: aspirin, SVD: spontaneous vaginal delivery, US: ultrasound, IOL: induction of labor, IVUS: intravenous ultrasound, LEIV: left external iliac vein. * a: index pregnancy, ‡ b: subsequent pregnancy.
| Case/Age | GP | History | GA at MTS Diagnosis | Diagnostic Modality | Management | Obstetric Outcome | Complications (Obstetric/Venous) |
|---|---|---|---|---|---|---|---|
| 1/29 | G2P2 | 9 | Doppler/Duplex US (DVT LCFV to tibial), MRI/A/V (DVT extending from IVC, LCIV, LCFV, c/w MTS), venography (MTS) | UFH, CDT, balloon angioplasty of LCIV and LSFV. Adjusted dose LMWH, continued through 8 wks PP, ASA, compression stockings. LCIV stent PP. | SVD at term | None | |
| 2a */29 | G1P1 | h/o DVT, known MTS with h/o LCIV stent | NA | Initial diagnosis with Duplex US (MTS) | Adjusted dose LMWH, transitioned to UFH, ASA, compression stockings. LMWH continued for 6 wks PP with ASA. | IOL at 39 wks, SVD Female 3690 g (83%) |
None |
| 2b ‡/32 | G2P2 | NA | Adjusted dose LMWH, transitioned to UFH, ASA, compression stockings. LMWH continued for 6 wks PP with ASA. | IOL at 40 wks, SVD Male 4470 g (98%) |
None | ||
| 3/33 | G2P2 | Known MTS with h/o LCIV stent, followed by complete stent occlusion | NA | Initial diagnosis with Duplex US, venogram/IVUS (MTS) | Adjusted dose LMWH, transitioned to UFH, ASA, compression stockings. LMWH bridged to warfarin postpartum. | IOL at 39, SVD Male 3060 g (27%) |
None |
| 4/33 | G4P4 | Pelvic/perineal varicosities | 3 | Duplex US (pelvic congestion, reflux and collaterals), venogram/IVUS (MTS) | LCIV and LEIV stents placed early pregnancy (prior to knowledge of pregnancy). Prophylactic LMWH transitioned to UFH, ASA, compression stockings. Prophylactic LMWH PP. | SVD at 39 Male, 3593 g (69%) |
Gonadal v. thrombosis 6 d PP, (single missed dose of LMWH) |