Amsterdam UMC cases: characteristics and outcomes for pregnancy in patients with in situ inferior vena cava filter
| Characteristics of patients at time of insertion IVC filter . | Pregnancy characteristics and obstetric outcomes . | Management and complications . | ||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Patient no. . | Age, y . | Thrombotic history . | Indication for filter and prepregnancy anticoagulant therapy . | Location, type, and timing of filter insertion . | Pregnancy no. . | Years since IVC filter . | Gravidity parity . | Mode of delivery . | Pregnancy outcome . | LMWH dose during pregnancy . | Pregnancy- related VTE?* . | Complications† IVC filter . |
| 1 | 31 | PE and mesenteric thrombosis | Surgery because of intra-abdominal bleeding 1 wk after acute PE DOAC (indefinite duration) | Infrarenal Retrievable (OptEase)‡ Outside pregnancy | 1 | 3 | G1P0 | Spontaneous vaginal delivery at 38w6d | Healthy neonate | Therapeutic | No | No |
| 2 | 21 | PE CTEPH, NYHA class II-III/IV | Pre-PEA VKA (indefinite duration) | Infrarenal Retrievable (OptEase)§ Outside pregnancy | 1 | 1 | G1P0 | Dilatation and curettage at <10 wk | Miscarriage | Therapeutic | No | No |
| 2 | 3 | G2P0 | Induced vaginal delivery at 41w6d | Healthy neonate | Therapeutic | No | No | |||||
| 3 | 5 | G3P1 | Induced vaginal delivery at 38w0d | Healthy neonate | Therapeutic | No | No | |||||
| 4 | 8 | G4P2 | Induced vaginal delivery at 38w4d | Healthy neonate | Therapeutic | No | No | |||||
| 3 | 29 | PE CTEPH, NYHA class III/IV | Pre-PEA VKA (indefinite duration) | Infrarenal Permanent (TrapEase) Outside pregnancy | 1 | 1 | G1P0 | Unknown, FU until 17 wk | Healthy neonate | Therapeutic | No | Noǁ |
| 4 | 27 | DVT | DVT in third trimester of pregnancy Low prophylactic LMWH since DVT diagnosis | Infrarenal Filter type unknown 30th week of pregnancy | 1 | 1 | G8P2 | Spontaneous vaginal delivery at 40w0d | Healthy neonate | Low prophylactic | Not during pregnancy | No |
| Characteristics of patients at time of insertion IVC filter . | Pregnancy characteristics and obstetric outcomes . | Management and complications . | ||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Patient no. . | Age, y . | Thrombotic history . | Indication for filter and prepregnancy anticoagulant therapy . | Location, type, and timing of filter insertion . | Pregnancy no. . | Years since IVC filter . | Gravidity parity . | Mode of delivery . | Pregnancy outcome . | LMWH dose during pregnancy . | Pregnancy- related VTE?* . | Complications† IVC filter . |
| 1 | 31 | PE and mesenteric thrombosis | Surgery because of intra-abdominal bleeding 1 wk after acute PE DOAC (indefinite duration) | Infrarenal Retrievable (OptEase)‡ Outside pregnancy | 1 | 3 | G1P0 | Spontaneous vaginal delivery at 38w6d | Healthy neonate | Therapeutic | No | No |
| 2 | 21 | PE CTEPH, NYHA class II-III/IV | Pre-PEA VKA (indefinite duration) | Infrarenal Retrievable (OptEase)§ Outside pregnancy | 1 | 1 | G1P0 | Dilatation and curettage at <10 wk | Miscarriage | Therapeutic | No | No |
| 2 | 3 | G2P0 | Induced vaginal delivery at 41w6d | Healthy neonate | Therapeutic | No | No | |||||
| 3 | 5 | G3P1 | Induced vaginal delivery at 38w0d | Healthy neonate | Therapeutic | No | No | |||||
| 4 | 8 | G4P2 | Induced vaginal delivery at 38w4d | Healthy neonate | Therapeutic | No | No | |||||
| 3 | 29 | PE CTEPH, NYHA class III/IV | Pre-PEA VKA (indefinite duration) | Infrarenal Permanent (TrapEase) Outside pregnancy | 1 | 1 | G1P0 | Unknown, FU until 17 wk | Healthy neonate | Therapeutic | No | Noǁ |
| 4 | 27 | DVT | DVT in third trimester of pregnancy Low prophylactic LMWH since DVT diagnosis | Infrarenal Filter type unknown 30th week of pregnancy | 1 | 1 | G8P2 | Spontaneous vaginal delivery at 40w0d | Healthy neonate | Low prophylactic | Not during pregnancy | No |
38w6d, 38 wk and 6 d of pregnancy; CTEPH, chronic thromboembolic pulmonary hypertension; DOAC: direct oral anticoagulant; FU, follow-up; G, gravidity; NYHA, New York Heart Association; P, parity; PEA, pulmonary endarterectomy; VKA: vitamin K antagonist.
During pregnancy or up to 6 wk postpartum.
Complications of IVC filter include: migration, tilt, fracture, penetration of the vena cava wall, IVC filter thrombosis, or bleeding caused by IVC filter complications.
Retrieval of IVC filter was attempted 4 wk after insertion and failed because the tip of the IVC filter was embedded in the endothelial wall. In an attempt to move the IVC filter, the IVC filter was slightly twisted. Retrieval remained impossible and the IVC filter was left in situ.
IVC filter was not removed after PEA surgery because this was complicated by a pulmonary bleeding and suspicion of heparin-induced thrombocytopenia
Radiologically confirmed: 6 mo before pregnancy, a venography showed an open IVC filter, 1 y after pregnancy abdominal x-ray showed an intact and correctly positioned IVC filter.