Pregnancy and thrombosis: Adrenal vein thrombosis. A retrospective descriptive study of 14 cases.

ABSTRACT

OBJECTIVES: Adrenal vein thrombosis during pregnancy is a rare thromboembolic event but is not exceptional. The objective of this study was to described the symptoms, diagnosis, treatment and follow-up of patients with this condition. STUDY DESIGN: This was a retrospective descriptive study of 14 cases (13 patients, one recurrence) that occurred in the three university maternity hospitals in Lyon (France) from 2008 to 2016. RESULTS: Adrenal vein thrombosis occurred exclusively in the third trimester (gestational age > 28 weeks), with most patients presenting unilateral lumbar pain (13/14 cases, 93%) and vomiting (8 cases, 57%), mimicking renal colic. To establish the diagnosis, all patients were examined by abdominal CT and all but three (79%) by abdominal ultrasonography. Ten patients (71%) were treated by low molecular weight heparin and the remaining four (29%) by unfractionated heparin. The delay between presentation and diagnosis, and thus before treatment was initiated, was greater than 24 h in 50% of cases. Thrombosis occurred predominantly (11 vs 3 cases) on the right adrenal vein. Labor inducing or cervical ripening agents were used after temporarily interrupting treatment for 9/14 patients (64%). Epidural anesthesia was possible for 11 patients (79%) and 2 (14%) had postpartum hemorrhage. Eleven patients received hemostatic function investigations with anomalies detected in four cases (36%). One of the six patients (16%) who had a second full-term pregnancy during the study period had a contralateral recurrence. CONCLUSIONS: Adrenal vein thromboses are rare events requiring curative anticoagulant therapy and labor management to minimize the risk of hemorrhage. Patients should receive thromboprophylaxis for subsequent pregnancies and a full thrombophilia investigation.