Successful multidisciplinary management of first-trimester inferior vena cava and iliofemoral thrombosis with elective late-preterm delivery and favorable long-term outcome: a case report

Objective To describe the multidisciplinary management of extensive first-trimester inferior vena cava (IVC) and iliofemoral thrombosis in a single patient, in whom an individualized, patient-requested elective delivery was performed at 34 weeks, with favorable short- and long-term outcomes. Results Extensive thrombosis involving the infrarenal IVC, left iliac veins, and left femoral veins was diagnosed. Thrombophilia workup demonstrated persistently elevated lupus anticoagulant (LA1 ratio 1.26–1.45), elevated coagulation factors (factor VIII 397%, factor II 158%, factor VII 155%, factor X 153%), and elevated PIC (1.2 µg/mL). Serial imaging demonstrated gradual IVC recanalization by 24 weeks, development of robust collateral circulation, and stable chronic thrombosis without extension. After repeated counseling and multidisciplinary review, and at the patient's request because of severe refractory anxiety and progressive post-thrombotic symptoms, elective induction was performed at 34 + 0 weeks. She delivered vaginally a healthy neonate weighing 2,450 g with Apgar scores of 8 and 9 at 1 and 5 minutes. No postpartum hemorrhage, pulmonary embolism, or thrombus extension occurred. At 8 months postpartum, follow-up imaging demonstrated recanalization of the left common femoral vein with slow flow and spontaneous echo contrast consistent with chronic post-thrombotic venous stasis. Conclusion In this single case, extensive first-trimester IVC and iliofemoral thrombosis was managed with therapeutic LMWH, serial venous imaging, and multidisciplinary planning, with a favorable maternal and neonatal outcome after an individualized, patient-requested delivery at 34 weeks. This report describes one management course and does not establish the safety or generalizability of late-preterm delivery, the clinical utility of serial PIC monitoring, or a benefit of hydroxychloroquine; these remain unproven and should not be adopted as general practice. Term delivery remains the recommended default for stable pregnancy-associated venous thromboembolism.