Key content Postpartum ovarian vein thrombosis (POVT) is a rare but potentially fatal condition. Symptoms up to 4 weeks postpartum often include vague abdominal pain and pyrexia. A high index of suspicion is required to make the diagnosis. As there is no consensus regarding management, a multidisciplinary approach is advised. Learning objectives Recognise the symptoms and signs of POVT and formulate a differential diagnosis. Recognise the importance of imaging in confirming the diagnosis and involvement of the multidisciplinary team to plan management. Understand that conservative management with low‐molecular‐weight heparin is the first‐line treatment, and understand the situations that may require vena caval filter insertion or surgical intervention. Ethical issues How can we counsel women about risks of conservative and surgical management of this condition when there is no consensus for this management? Should women who have had an ovarian vein thrombosis in a previous pregnancy be counselled toward avoiding future pregnancy?

In women with twins who present in spontaneous labor between 32 + 0 and 38 + 6 weeks' gestation, where the first twin is cephalic, a policy of planned vaginal delivery or cesarean is not associated with significant differences in neonatal or maternal outcomes.