title: Septic pelvic thrombophlebitis and preeclampsia are related disorders.
abstract: OBJECTIVE
  To elicit factors associated with the postpartum development of septic pelvic thrombophlebitis in a single large referral tertiary patient population.
  
  
  METHODS
  A nine-year single institution retrospective case review of all patients with enigmatic fever and septic pelvic thrombophlebitis was analyzed.
  
  
  RESULTS
  A total of 55 patients with septic pelvic thrombophlebitis were provided care during the study interval. The average gestational age at delivery was 36.8 +/- 4.3 weeks. The most prevalent concurrent medical complication of pregnancy was preeclampsia (45%) while chorioamnionitis affected only 13%. The average length of ruptured membranes was 22.8 +/- 56.8 hours (median 10.5, 95% confidence interval [CI] 7.0-38.7 hours), with 22% of patients undergoing amnion rupture at the time of cesarean delivery. Prolonged (>24 hours) amnion rupture occurred in only 9% of patients. Most affected patients were delivered abdominally (91%) but a minority delivered vaginally (9%). Antibiotic therapy for presumed infection was initiated at 27.4 +/- 24.6 hours postpartum. Subsequently intravenous heparin therapy was initiated 128.9 +/- 54.2 hours thereafter enigmatic fever defervesed 37.2 +/- 36.8 hours later (median 34.0, 95% CI 27.2-47.3 hours). Patients received 6.3 +/- 1.8 days of heparin therapy.
  
  
  CONCLUSIONS
  In this series, septic pelvic thrombophlebitis was frequently preceded by cesarean delivery and commonly associated with preeclampsia. Unexpectedly, a small number of patients suffered prolonged rupture of membranes or chorioamnionitis. We speculate that the cesarean delivery of a population of at-risk patients with preeclampsia may predispose them to develop septic pelvic thrombophlebitis.
authors.affiliation: Department of Obstetrics and Gynecology, East Carolina University Brody School of Medicine, Greenville, North Carolina, USA. islerc@mail.ecu.edu
authors.forename: Christy M
authors.initials: CM
authors.lastname: Isler
authors.forename: Brian K
authors.initials: BK
authors.lastname: Rinehart
authors.forename: Dom A
authors.initials: DA
authors.lastname: Terrone
authors.forename: J Holt
authors.initials: JH
authors.lastname: Crews
authors.forename: Everett F
authors.initials: EF
authors.lastname: Magann
authors.forename: James N
authors.initials: JN
authors.lastname: Martin
mesh_terms: D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D015992:Body Mass Index; D002821:Chorioamnionitis / Q000150:complications / Q000188:drug therapy / Q000453:epidemiology; D036861:Delivery, Obstetric; D005260:Female; D005334:Fever / Q000150:complications / Q000188:drug therapy / Q000453:epidemiology; D005343:Fibrinolytic Agents / Q000627:therapeutic use; D005500:Follow-Up Studies; D016908:Gram-Positive Bacterial Infections / Q000150:complications / Q000188:drug therapy / Q000453:epidemiology; D017359:HELLP Syndrome / Q000150:complications / Q000188:drug therapy / Q000453:epidemiology; D006493:Heparin / Q000627:therapeutic use; D006801:Humans; D015994:Incidence; D008429:Maternal Welfare; D008922:Mississippi / Q000453:epidemiology; D000292:Pelvic Inflammatory Disease / Q000150:complications* / Q000188:drug therapy / Q000453:epidemiology; D010388:Pelvis / Q000098:blood supply*; D011225:Pre-Eclampsia / Q000150:complications* / Q000188:drug therapy / Q000453:epidemiology; D011247:Pregnancy; D011256:Pregnancy Outcome; D011645:Puerperal Infection / Q000150:complications / Q000188:drug therapy / Q000453:epidemiology; D012189:Retrospective Studies; D018805:Sepsis / Q000150:complications* / Q000188:drug therapy / Q000453:epidemiology; D013924:Thrombophlebitis / Q000150:complications* / Q000188:drug therapy / Q000453:epidemiology; D014219:Trial of Labor; D014640:Vancomycin / Q000627:therapeutic use
chemical_list: D000900:Anti-Bacterial Agents; D005343:Fibrinolytic Agents; D014640:Vancomycin; D006493:Heparin