The prevalence of incidental uterine venous plexus thrombosis in women attending a gynecology clinic

Abstract

Background: The uterine venous plexus (UVP) is an unusual site for venous thrombosis (VT). Our aim was to determine the prevalence of UVP thrombosis (UVPT) and identify associated risk factors. Methods: We conducted a cross-sectional study on consecutive nonpregnant women attending our general gynecology clinic with a wide variety of presenting symptoms over a 16-month period. All women underwent a transvaginal ultrasound scan which involved detailed examination of the uterine venous plexus. Women diagnosed with incidental UVPT had thrombophilia screening, lower limb venous duplex imaging, and specialist hematological review. Logistic regression was used to examine associations between various risk factors and UVPT. Results: We screened 1383 women, 39 of whom had an incidental UVPT, giving a prevalence of 3.0% (95% confidence interval [CI], 2.1%-4.1%). Multivariate analysis showed positive associations between multiparity (odds ratio [OR] 5.75 [95% CI 2.10, 15.7]), recent surgery (OR 3.10 [95% CI 1.19, 8.07]), presence of leg varicose veins (OR 3.15 [95% CI 1.32, 7.49]), and a family history of venous thromboembolism (OR 8.74 [1.65, 46.4]) and negative associations between postmenopausal status (OR 0.36 [95% CI 0.13, 0.95]) and the development of UVPT. Thrombophilia was detected in 12.8% women diagnosed with UVPT. Conclusions: The prevalence of incidental UVPT in a general gynecology population was 3.0%. Several demographic and clinical factors were found to be associated with UVPT. This could help to identify women at risk of this condition, and facilitate its early detection and development of evidence-based management strategies.

The Natural History of Uterine Venous Plexus Thrombosis

“…There was no difference in the overall resolution rates between women who received anticoagulation and those who had expectant management without anticoagulation. We found that there were several risk factors associated with the development of UVPT, including multiparity, pre-menopausal status, a recent surgery within four months, the presence of varicose veins of the legs, and a family history of VTE in a first-degree relative [2]. However, we did not find any significant factors that were associated with resolution.…”

“…The main strength of this study is that it is novel and the prospective study design permitted the evaluation of the natural history of UVPT. This current study, and our previous work on the prevalence of UVPT [2], can provide clinicians with a preliminary management pathway to follow. We have provided information that can be used to counsel patients diagnosed with UVPT on the clinical significance and likelihood of resolution.…”

“…Our study has shown that in a high proportion of women, incidental UVPT could be managed expectantly without the need for anticoagulation, but the overall management of UVPT should be based on the individualised clinical risk assessment. Adopting a multi-disciplinary approach between haematology and gynaecology provides a supportive structure for both clinicians and patients in managing this condition, which has a reported prevalence of 3% [2]. Given that post-thrombotic syndrome (PTS) can develop within two years following acute DVT [24], further prospective studies on the long-term follow up of women with UVPT are warranted, as well as establishing whether this could be a source of pelvic pain and/or pulmonary embolism.…”

“…In addition to the TVS examination, all women diagnosed with UVPT had baseline thrombophilia screens and lower limb venous duplex scans to exclude concomitant lower limb DVT. They were referred to a consultant haematologist (H.C.) specialising in thrombosis and haemostasis for assessment, as well as clinical advice on management and risk-reduction measures against thrombosis as per routine clinical practice, based on the study protocol, which has been described previously [2]. Women considered to be at a potentially higher risk for VTE, as defined above, were advised to have thromboprophylactic low-molecular weight heparin (LMWH).…”

“…Studies have shown that the risk of propagation and embolism is low with incidental calf deep venous thrombosis (DVT) [1], however management is often extrapolated from studies on symptomatic DVT. Our previous study has shown that the prevalence of uterine venous plexus thrombosis (UVPT) is approximately 3% in women attending gynaecological clinics [2]. Once diagnosed, UVPT can present clinicians with a management dilemma.…”