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Obstetric Anaesthesia Annual Scientific Meeting 2025
May 15 - 16, 2025 | ICC, 2 Lanyon Place, Belfast BT1 3WH
6779471
Management of caesarean birth in patient with congenital inferior vena cava agenesis
Part of Topic
Case report
Management of caesarean birth in patient with congenital inferior vena cava agenesis
J Keohone, A Primrose
Queen Elizabeth University Hospital, Glasgow
Congenital complete absence of the inferior vena cava (IVC) is a rare vascular abnormality, estimated to affect 0.0005% of the population. We present a patient with diagnosed IVC agenesis requiring a planned caesarean birth (PCB).
Case report:
- 38-year-old primigravida, maternal request caesarean birth at 38+5 weeks
- Diagnosed with complete infra-renal IVC agenesis at 33 years old on MRI (figures 1 and 2), original presentation withback pain
- History of chronic secondary hypertension and needle phobia
- Widespread collateral circulation with dilatation of vertebral venous plexus, abdominal wall vessels, paravertebral and azygous veins
- Uneventful general anaesthesia for PCB
- Risk of post-partum haemorrhage given risk of abormal abdominal wall and pelvic venous anatomy
Discussion:
- No described cases of IVC agenesis in a pregnant patient in literature
- Twice as common in males
- Often presents as lower limb swelling, unprovoked deep vein thrombosis or chronic back pain
- Association with congenital abnormalities of urogenital tract
- Pregnancy compounds risks of venous thromboembolism due to venous stasis caused by gravid uterus in dependent circulation and hyper-coagulability
Learning points:
- High index of suspicion for vascular anomalies in patients with unprovoked DVT
- Importanceof multi-disciplinary planning for delivery in complex patients
- Optimisation of preloadand venous return in anaesthetic strategy
- Careful consideration of thromboprophylaxis throughout pregnancy and post-partum
References:
1 Martinez Garcia D et al. Congenital abnormalities of inferior vena cava. European Journal of Internal Medicine 2024; 119: 154-6. https://doi.org/10.1016/j.ejim.2023.10.034
2 Saab K et al. Systematic review of inferior vena cava atresia. Journal of Vascular Surgery, Venous and Lymphatic Disorders 2023; 11(6): 1253-64. https://doi.org/10.1016/j.jvsv.2023.07.002