Inferior Vena Cava Filter Use in Pregnancy: Preliminary Experience

Altered coagulation during pregnancy increases the risk of thromboembolic disorders. At present, thromboembolism is the commonest direct cause of maternal death in the United Kingdom. Use of an inferior vena cava (IVC) filter is warranted to prevent life-threatening complications including pulmonary embolism when thromboembolism recurs despite adequate anticoagulation, or when anticoagulant therapy is contraindicated. The investigators retrospectively reviewed pregnancy outcomes in 6 women who, during 12 pregnancies at the same center over the past 11 years, had an IVC filter in place. In 8 instances the filter was in place before pregnancy and was retained throughout gestation. In 4 others a filter was placed during pregnancy. The filters were inserted under fluoroscopic guidance through the internal jugular vein in 4 women and through the femoral vein in 2 women treated before pregnancy. Three women received permanent and 3 received retrievable filters. Four infants in this series were delivered vaginally. Four others had elective cesarean section, and 4 underwent emergency section because of fetal distress in labor. No antenatal complications were ascribed to placement of an IVC filter and, when a filter was in place before conception, there were no recurrences of thromboembolism. Birth weights averaged 2982 gm. All infants were in good condition at birth with normal Apgar scores. These results tentatively support the use of an IVC filter when indicated to prevent complications of thromboembolism during pregnancy.