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Inferior Vena Caval and Ovarian Vein Ligation for Antepartum Pulmonary Thromboembolism

Richard D. Sautter, MD; Fred W. Fletcher, MD; Russel F. Lewis, MD; Frederick J. Wenzel
JAMA. 1966;196(3):290-292. doi:10.1001/jama.1966.03100160140047.
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MASSIVE PULMONARY thromboembolism in the antepartal period is a rare but often fatal condition. This disease has been estimated to cause 18 deaths per 1 million pregnancies each year.1 The precise etiology is obscure. Maternal mortality without treatment has been reported to vary from 15% to 60%.2,3 The usual therapy consists of anticoagulation with sodium heparin or sodium warfarin.4 However, when sodium warfarin is used, the fetal mortality rate (18%) is excessive. Fatal results from recurrent pulmonary thromboembolism have been reported in patients in which the anticoagulant state was maintained with sodium heparin.5,6 Ligation of the inferior vena cava and ovarian veins offers near absolute protection against further and possibly fatal pulmonary embolism. This procedure was carried out in the patient in the case to be reported, with the survival of the mother and baby.

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