[Grave obstetrical phlebitis. Physiopathology, diagnosis and treatment (6 case histories) (author's transl)].

The authors detail their concepts of the physiopathology, the diagnostic methods and the treatments of grave puerperal phlebitis, having seen six cases in their two departments recently. They consist of 5 cases of iliofemoral thrombosis, 2 of whom were diagnosed during their pregnancies and 3 others whom were diagnosed after delivery. One of these died of pulmonary embolus: and there was one case of thrombosis of the right ovarian vein during post-partum. Over and above the classical factors that predispose to this condition in pregnancy, the authors draw attention to the anatomical constitutional factors that have been observed by Cockett in the physiopathology of these cases. The diagnosis is made using non-invasive methods: Doppler, plethysmography, labelled fibrinogen and isotope phlebography after delivery, supplemented when the results are positive by radiography of the iliac and vena caval systems which alone gives a precise diagnosis of the site. Therapeutic possibilities change according to the time that the condition is perceived, according to the topography of the lesions, and according to the existence or non-existence of moving thrombi. The treatment is directed to avoiding the complications of emboli and to preventing secondary functional sequellae. Finally the gynaecological problems of contraception and of further pregnancies are considered.