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

Article type: Case Report

Authors: Poliektov, Natalie^a | Kahn, Bronwen F.^{b; *}

Affiliations: [a] Department of Gynecology and Obstetrics, Emory University School of Medicine, Atlanta, GA, USA | [b] Obstetrix Medical Group of Colorado, Denver, CO, USA

Correspondence: [*] Address for correspondence: Bronwen F. Kahn, MD, 2055 High St. Suite 230, Denver, CO 80205, USA. Tel.: +1 303 860 9990; E-mail: Bronwen Kahn@MEDNAX.com.

Abstract: 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.

DOI: 10.3233/NPM-200667

Journal: Journal of Neonatal-Perinatal Medicine, vol. 15, no. 1, pp. 195-202, 2022