Cervical varices: An unusual source of first-trimester hemorrhage

Cervical varicosities, an uncommon cause of third-trimester bleeding in pregnancy: A case report

Cervical varicosities are dilated cervical veins and are uncommon causes of third-trimester vaginal bleeding. Early identification of patients with cervical varices is critical to prevent postpartum hemorrhage, which increases the risk of maternal morbidity and mortality. This is a case report of a 30-year-old woman, gravida 2 para 1, who presented to the labor and delivery unit at 35 weeks 6 days of gestation with a singleton pregnancy with vaginal bleeding. She underwent a pelvic exam under anesthesia and was found to have a 5x5 cm mass of varicosities protruding from the external cervical os, extending over the anterior vaginal lip to the anterior vaginal fornix. A decision was made to deliver via cesarean section. Intraoperative findings were significant for 800 cc of blood loss and a 5-6 cm right ovarian teratoma, which was excised. The patient received two units of packed red blood cells for acute blood-loss anemia postoperatively. This case is unique as the patient had none of the established risk factors for the development of cervical varices. Due to the risks of hemorrhage, morbidity and mortality, physicians and healthcare providers should include cervical varices in their differential diagnoses of patients who present with vaginal bleeding.

Pessary for Management of Cervical Varices Complicating Pregnancy

BACKGROUND

Cervical varices complicating pregnancy are rare but can cause significant maternal and perinatal morbidity. There is limited evidence regarding the optimal management of bleeding caused by cervical varices during pregnancy.

CASE

A 38-year-old woman was admitted to the hospital at 16 weeks of gestation due to vaginal hemorrhage in the setting of cervical varices accompanied by placenta previa. A cervical pessary was placed at 21 weeks of gestation without further bleeding. Magnetic resonance imaging demonstrated variceal reduction after pessary placement, and a cesarean delivery was performed at 36 weeks of gestation without complications.

CONCLUSION

Cervical pessary should be considered as conservative option to control the bleeding associated with cervical varices during pregnancy.

Bleeding cervical varices in pregnancy: A case report and review of the literature

BACKGROUND

Venous varicosities are a relatively common finding during pregnancy. Rarely, varices can arise in the cervix and cause life-threatening maternal hemorrhage. This article offers an example of a patient who was diagnosed with bleeding cervical varices during pregnancy and summarizes the diagnosis and treatment strategies for the 20 other reported cases in the literature.

METHODS

A PubMed literature search using the following terms was performed to gather data for the literature review: "bleeding" or "hemorrhage" and "cervical varices" or "cervical varix" or "cervical varicosities" and "pregnancy" or "obstetric" or "maternal." Individual references cited in each article were also evaluated for inclusion in this review.

RESULTS

A 50-year-old gravida 7 para 1 presented at 12 4/7 weeks with vaginal bleeding. Endo-vaginal ultrasound showed enhanced color Doppler signal in the endocervical canal. During a speculum exam, she was found to have active bleeding from ruptured cervical varicosities and required blood and fresh frozen plasma transfusion. Hemostasis was achieved with interrupted suture ligation. A McDonald cerclage was subsequently placed. She continued pregnant until delivery via cesarean section at 37 2/7 weeks. To date, there have only been 20 other reported cases of bleeding cervical varices during pregnancy.

CONCLUSIONS

This case report and review of the literature highlight the importance of including bleeding cervical varices in the differential diagnosis of maternal hemorrhage and offer a treatment strategy if cervical varicosities are discovered during pregnancy.