title: Intrapartum placement of an inferior vena cava filter for a woman with hereditary antithrombin III deficiency: its role in the prevention of fatal pulmonary embolism.
abstract: We present a case of a pregnant woman with hereditary antithrombin III deficiency and deep vein thrombosis of the left lower extremity managed by perinatal unfractionated heparin injection with antithrombin III replacement as well as by intrapartum placement of a temporary inferior vena cava filter. A massive thrombus of the right common iliac vein occurred during the intrapartum period despite antithrombin III replacement. An inserted filter could prevent fatal pulmonary embolism in this patient. Hereditary antithrombin III deficiency increases risk of thrombosis during pregnancy. However, discussion on intrapartum management, when anticoagulants are contraindicated due to possible hemorrhage, is minimal. Our experience suggests that thrombosis can occur and develop during the intrapartum period in an antithrombin III deficient woman despite antithrombin III replacement. It may be advisable to manage deliveries with temporary inferior vena cava filters to prevent fatal pulmonary embolism.
authors.affiliation: Department of Obstetrics and Gynecology, Graduate School of Medical Sciences, Kyushu University, Higashiku, Fukuoka, Japan. n-hidaka@kpa.biglobe.ne.jp
authors.forename: Nobuhiro
authors.initials: N
authors.lastname: Hidaka
authors.forename: Masahiro
authors.initials: M
authors.lastname: Hachisuga
authors.forename: Kiyomi
authors.initials: K
authors.lastname: Tsukimori
authors.forename: Toshihiro
authors.initials: T
authors.lastname: Onohara
authors.forename: Yoshihiko
authors.initials: Y
authors.lastname: Maehara
authors.forename: Norio
authors.initials: N
authors.lastname: Wake
mesh_terms: D000328:Adult; D020152:Antithrombin III Deficiency; D036861:Delivery, Obstetric; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D007744:Obstetric Labor Complications / Q000000981:diagnostic imaging / Q000473:pathology / Q000517:prevention & control*; D011247:Pregnancy; D011250:Pregnancy Complications, Hematologic; D011655:Pulmonary Embolism / Q000000981:diagnostic imaging / Q000473:pathology / Q000517:prevention & control*; D011859:Radiography; D011877:Radionuclide Imaging; D016306:Vena Cava Filters