Cervical varices complicated by thrombosis in pregnancy

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.

Four cases of cervical varices without placenta praevia: Presentation, diagnosis, managements, and literature review

Cervical varices are a rare condition characterized by recurrent antepartum hemorrhage and less than 20 cases were reported in the literature. It is usually associated with placenta previa. We herein describe four cases of cervical varices without placenta previa. Meticulous speculum examination, ultrasonography with Doppler and colposcopy are essential for establishing the diagnosis and assessing the extent of the cervical varix. We propose to classify it as the apparent external os type or ultrasonography-based endocervical type. Most cases presented in the literature were delivered by cesarean section. Nevertheless, one of our cases was a successful vaginal delivery. Our case illustrates that vaginal delivery is possible in isolated cervical varices. More case reports are needed to have a better understanding of this rare entity.

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.

Cervical varix with thrombosis diagnosed in the first trimester of pregnancy

Cervical varix is rare and can develop due to various conditions in pregnancy. Most cases of cervical varix during pregnancy are diagnosed in the second or third trimester and are usually associated with abnormal placental location, such as placenta previa or low-lying placenta. A 23-year-old woman with cervical varix bleeding visited our institution at 8 weeks of gestation. This case report describes cervical varix bleeding that developed into a venous thrombus in the first trimester. Ultrasonography with color Doppler and magnetic resonance imaging could be helpful in diagnosis.

Cervical varices: An unusual source of first-trimester hemorrhage

Endocervical varices are a rare cause of obstetrical hemorrhage. Usually presenting in the second and third trimesters, bleeding varices often require pregnancy termination or indicated preterm birth via cesarean delivery. Our patient experienced variceal hemorrhage at 12 weeks' gestation in a dichorionic twin pregnancy conceived through in vitro fertilization. A low-lying placenta resolved at 19 weeks followed by variceal regression at 22 weeks' gestation. Endocervical varices causing first-trimester hemorrhage may regress with resolution of a coexisting low placental implantation, permitting planned vaginal delivery, despite progressive hemodynamic changes of pregnancy. © 2017 Wiley Periodicals, Inc. J Clin Ultrasound 46:218-221, 2018.

Cervical varicosities and placenta praevia

INTRODUCTION

Cervical varicosities (CVs) have been reported infrequently in pregnancy and have been associated with significant antepartum and postpartum haemorrhage. The most common association with CVs in pregnancy in the literature is placenta praevia.

AIMS

To further investigate the association between placenta praevia and CVs.

METHODS

A retrospective audit of all cases of placenta praevia that had an ultrasound in the Feto-Maternal Unit at Liverpool Hospital over the period January 2001 to January 2012. Patient outcomes were obtained from the hospital paper and electronic medical records, including mode of delivery and blood loss.

RESULTS

Eighty-four cases of placenta praevia were identified, and 78 had saved images that were reviewed. 51 of these 78 cases had transvaginal ultrasound (TVUS) images, which identified nine further cases of cervical varicosities. All cases of CVs were complicated by APH and delivered by caesarean section. There was no significant difference in the blood loss at delivery between the placenta praevia with CVs and those without (925 vs 870 mLs P = 0.3877).

CONCLUSIONS

Cervical varicosities are not as rare as the literature would suggest. The clinical relevance of the additional finding of CV on TVUS in cases of placenta praevia is questionable.

Pregnancy complicated by cervical varix and low-lying placenta: a case report

We present a case of cervical varix and low-lying placenta. A cesarean section was performed because of the risk of bleeding with vaginal delivery; hemostasis was achieved using z sutures at the bleeding points. After delivery, the cervical varix decreased dramatically in size. It is important to recognize the clinical features and available treatments for cervical varix.

The vascular architecture of the supravaginal and vaginal parts of the human uterine cervix: a study using corrosion casting and scanning electron microscopy

The aim of this study was to visualize and describe the vascular architecture of the vaginal and supravaginal parts of the human uterine cervix. Uteri collected at autopsy (n = 42) were perfused via the afferent vessels with fixative followed by Mercox resin. After polymerization of the resin, corrosion was performed. The obtained vascular casts of the cervix, visualizing all vessels including capillaries, were examined using scanning electron microscopy. Both in the vaginal and supravaginal parts of the cervix, four distinct vascular zones were distinguished - the outer zone containing large arteries and veins, the arteriole and venule zone, the endocervical mucosal capillaries zone and the pericanalar zone containing small veins and capillaries. In the pericanalar zone ran small veins, responsible for draining the mucosal capillaries. Both in the muscular layer, as well as in the pericanalar zone, arterioles and venules passed close to each other, often adjoining. This study introduces the idea of two systems responsible for draining blood from the mucosal capillaries. It is also the first to suggest the possible existence of a countercurrent transport between adjoining veins and arteries.