Inferior Vena Cava Filter Placement in Pregnancy and the Postpartum Period: A Single-Center Experience

Background: Guidelines recommend placement of inferior vena cava filters (IVCF) in patients with acute proximal lower extremity deep vein thrombosis (DVT) and a contraindication to anticoagulation. IVCF placement during pregnancy or immediately postpartum presents technical challenges and is not extensively described in the existing literature. Objective(s): To describe the use of IVCF in the obstetric population along with outcomes related to filter placement. Methods: Retrospective chart review of all patients at Mayo Clinic from 2001-2020 with an IVCF at the time of conception or who underwent placement during pregnancy/postpartum. Results: 24 pregnancies in 23 women (mean age 26.3 years, range 18-41) were included: 5 (21%) with IVCF placement prior to pregnancy, 7 (29%) during pregnancy, and 12 (50%) during postpartum. IVCF placed during pregnancy were frequently in the suprarenal position, in 5 (71%) cases. Meanwhile, 16 (94%) were deployed in an infrarenal position prior to pregnancy and postpartum. Complications included multiple attempts to remove the IVCF (n=2), severe angulation (n=4), embedded struts (n=3), fracture (n=1), and one case of cardiac tamponade (n=1). Complications were more common when placement was performed prior to pregnancy or during pregnancy (2, 40% and 4, 57% respectively) versus postpartum (2, 17%). Conclusion(s): IVCF placement prior or during pregnancy/ postpartum is uncommon and is associated with a high incidence of complications, although most did not fundamentally impact clinical outcomes. While IVCF remain an option for clinicians treating pregnant and postpartum patients, these should be considered as a last resource.