Internal jugular vein thrombosis in patients with ovarian hyperstimulation syndrome

Objective: To describe a case of bilateral internal jugular vein thrombosis complicating ovarian hyperstimulation syndrome (OHSS). Design: Case report. Setting: Internal medicine ward in a teaching hospital. Patient: A 28-year-old nulliparous woman undergoing IVF. Intervention(s): Ultrasonographic Doppler of the neck veins was performed because of pain and swelling in the neck, and bilateral jugular vein thromboses were detected. Laboratory evaluation revealed activated protein C resistance caused by factor V Leiden mutation. Low-molecular-weight heparin (enoxaparin) was administered for the remainder of the pregnancy and for 6 weeks after delivery. Main Outcome Measure: Resolution of jugular venous thromboses documented by ultrasonographic Doppler and normal progression of pregnancy. Result(s): The patient delivered healthy twins at term. There were no complications arising from the jugular vein thrombosis or the low-molecular-weight heparin treatment. Conclusion(s): Unusually located venous thrombosis should prompt an evaluation for a hypercoagulable state. The high prevalence (4% - 7%) of factor V Leiden mutation in most Western populations and the mutation's potential contribution to thrombotic complications in OHSS suggest that screening for this abnormality in women undergoing IVF may be indicated. ((C) 1998 by American Society for Reproductive Medicine.).