Abstract
Puerperal sepsis (PPS) is a severe postpartum infection that remains a significant
maternal health concern. Recent evidence suggests a potential link between PPS and
ovarian vein thrombosis (OVT), a rare but life-threatening complication occurring
in 0.01 to 0.18% of pregnancies. Despite the historical significance of PPS and its
well-documented consequences, its association with thrombosis remains underrecognized
in obstetric practice. This narrative review explores the historical context, clinical
presentation, diagnosis, and management of PPS and OVT while emphasizing the need
for increased awareness and preventive strategies. Sepsis triggers a hypercoagulable
state through inflammatory cytokine release, endothelial injury, and coagulation activation,
contributing to thrombotic complications such as OVT. The right ovarian vein is more
commonly affected due to anatomical factors, including uterine dextrorotation during
pregnancy. OVT typically presents with abdominal pain and fever, requiring imaging
modalities such as Doppler ultrasound and magnetic resonance imaging for diagnosis.
Although anticoagulation therapy is widely used for deep vein thrombosis, its application
in OVT remains inconsistent, despite comparable recurrence rates between the two conditions.
The review also highlights the lack of consensus on thromboprophylaxis in septic postpartum
patients. Although guidelines from major obstetric organizations are inconsistent,
emerging evidence suggests that low-molecular-weight heparins may reduce thrombotic
risk in PPS. In the absence of large-scale randomized trials, observational studies
remain essential for guiding clinical decisions.
Keywords
puerperal infection - embolism and thrombosis - ovary
