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OVARIAN CYSTECTOMY IN A SECOND TRIMESTER PREGNANT PATIENT WITH DEEP VENOUS THROMBOSIS

KREŠIMIR REINER ; Zagreb University Hospital Center, Department of Gynecology and Obstetrics, Department of Anesthesiology and Intensive Care, Zagreb, Croatia
ANA VUZDAR TRAJKOVSKI ; Zagreb University Hospital Center, Department of Gynecology and Obstetrics, Department of Anesthesiology and Intensive Care, Zagreb, Croatia
MATIJA MAJIĆ ; Zagreb University Hospital Center, Department of Gynecology and Obstetrics, Department of Anesthesiology and Intensive Care, Zagreb, Croatia
IVAN PARIPOVIĆ ; Zagreb University Hospital Center, Department of Gynecology and Obstetrics, Department of Anesthesiology and Intensive Care, Zagreb, Croatia
LJILJANA MIHALJEVIĆ ; Zagreb University Hospital Center, Department of Gynecology and Obstetrics, Department of Anesthesiology and Intensive Care, Zagreb, Croatia
SLOBODAN MIHALJEVIĆ ; Zagreb University Hospital Center, Department of Gynecology and Obstetrics, Department of Anesthesiology and Intensive Care, Zagreb, Croatia

Abstract

This is a case report on a 34-year-old primigravida diagnosed with ovarian cyst and deep venous thrombosis in the 9th gestational week. The patient was initially treated with therapeutic values of low molecular weight heparin. When follow up ultrasonography scan in the 15th week of gestation showed deep vein patency of the leg veins, the patient was prepared for surgery. Considering dimension of the tumor, it was safer to perform laparotomy. Anesthetic management, surgical procedure and postoperative period were uneventful. Antithrombotic prophylaxis was continued throughout the rest of pregnancy. The patient had an uneventful vaginal delivery at the 39th week of gestation. Surgical removal of large adnexal masses during pregnancy is considered to reduce the risk of undiagnosed malignancy, torsion, infection, rupture, hemorrhage, and obstruction of labor. Considering the proven deep venous thrombosis, treatment for deep venous thrombosis was initiated with therapeutic values of subcutaneous low molecular weight heparin. Other potential therapeutic measures
include placement of inferior vena cava fi lters, treatment with unfractionated heparin, and thrombolysis/thrombectomy. Several studies suggest similar vaginal delivery rates between the patients receiving prophylactic low molecular weight heparin and the general obstetric population. We decided to continue with antithrombotic prophylaxis throughout the rest of pregnancy, which also proved to be the right choice because the patient had uncomplicated vaginal delivery at 39th week of gestation. Our experience gained from this case suggests good response to treatment of deep venous thrombosis with
low molecular weight heparin during pregnancy. We can also confi rm that adnexal masses during pregnancy are ideally managed in the second trimester after organogenesis has been completed. The true benefi t of intraoperative positive end expiratory pressure as a measure of prevention of pulmonary embolism is yet to be established.

Keywords

pregnancy; deep venous thrombosis; ovarian cyst

Hrčak ID:

197903

URI

https://hrcak.srce.hr/197903

Publication date:

3.4.2018.

Article data in other languages: croatian

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