The procedure was uncomplicated, and her fetus was found to be viable. For the short cervix, a rescue McDonald cerclage of the cervix was favored over 17-α-hydroxy-progesterone therapy because of this patient’s risk of clotting. The decision was made to start therapy with heparin. The patient’s treatment plan was discussed in an interdisciplinary manner among the departments of internal medicine, hematology, vascular surgery, and obstetrics and gynecology. The arrows points to the occlusive thrombosis identified in the soleal vein. Venous duplex ultrasonography of the right calf of a 37-year old pregnant woman presenting with calf pain. The right lower extremity starting just below the popliteal fossa posteriorly was visibly more edematous than the left, and prominent TART (tenderness, asymmetry, restricted motion, tissue texture) changes were identified on the right calf. An osteopathic structural examination performed on the thoracic and lumbar spines and lower extremities revealed that T1-9 was neutral, rotated right, sidebent left T10-12, flexed, rotated right, sidebent right L1-2, flexed, sidebent, rotated right 元-5, flexed, sidebent right, rotated right and a posterior right fibular head. Venous duplex ultrasonography demonstrated an acute occlusive right ISVT ( Figure 1) with no evidence of acute or chronic thromboses in the common femoral, deep femoral, femoral, popliteal, or posterior tibial veins on either side. The patient denied any chest pain, shortness of breath, fever, chills, or any other symptoms. Results of a workup for thrombophilic disorders were negative. The most recent sonogram demonstrated a cervical length of 9 mm with funneling. The remaining 9 pregnancies resulted similarly, with nonviable preterm deliveries before 20 weeks and gestational ages ranging between 12 and 16 weeks despite similar interventions. A cerclage had been placed during her fifth pregnancy, but the patient delivered at 20 weeks. The patient’s miscarriages occurred between 12 and 14 weeks. Her obstetric history was gravida 15, para 0, and aborta 13. She had been referred by the Department of Maternal and Fetal Medicine for cerclage placement. Report of CaseĪ 37-year-old pregnant woman with a short cervix and a gestational age of 14 weeks presented to the Department of Obstetrics and Gynecology with right calf pain that worsened with movement. We present a case of a pregnant woman with a short cervix and acute ISVT. 8 Despite its frequency, the phenomenon of isolated soleal vein thrombosis (ISVT) is one of the most debated issues in the field of VTE, and clear guidelines for the management of this clinical problem remain to be defined, especially when concurrent with pregnancy. 5- 7 A 20% incidence is widely quoted, but new imaging methods point to a higher frequency. 4 Conflicting data have been reported by several studies regarding the incidence of propagation of calf vein thrombosis, specifically soleal vein thrombosis, in the proximal deep veins of the leg. 3 Isolated iliac vein and calf vein thromboses occur in approximately 17% and 6% of cases, respectively. When VTEs occur during pregnancy, more than 90% of them occur in the left leg. Approximately 70% of cases are located in the iliofemoral veins without involvement of the calf veins. 1, 2 During pregnancy, most VTEs are confined to the deep veins of the lower extremities, which include all of the infrapopliteal deep veins of the lower limbs. The risk of venous thromboembolism (VTE) in pregnant women is 4 to 5 times higher than that in nonpregnant women.
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