The Management and Maternal Outcomes of Cervical Varicosities in Pregnancy: Spontaneous Vaginal Delivery in the Setting of Cervical Varicosities KA Whitsell, MD, MJ McKuen MD, PhD, and VB Mello, DO Department of Obstetrics and Gynecology, Central Michigan University, Saginaw, MI ABSTRACT CASE PRESENTATION CONCLUSIONS Postpartum hemorrhage is one of the most common maternal A Caucasian 18-year-old G2P0101 at 30w2d presented to labor • There is a great need to establish management guidelines morbidities, which has increased by greater than fifty percent from and delivery at a outlying facility with pelvic pressure and vaginal for cervical varicosities in pregnancy to minimize 1993 to 2014 [2]. Although cervical varicosities are rare in spotting. A transvaginal ultrasound (TVUS) revealed a hypoechoic pregnancy, they have been associated with placenta previas and structure in the posterior cervix that was suspicious for an antepartum and postpartum hemorrhages. low-lying placentas as well as significant antepartum and arteriovenous malformation. She was found to be anemic with a • The mode of delivery in the absence of abnormal postpartum hemorrhage[1-3,8-9,11-13,15]. Cervical varicosities are hemoglobin of 7.7 and received a blood transfusion. A few weeks placental implantation should be decided based on the thought to be the result of inferior vena cava compression by the later, she returned with preterm contractions. She was initiated on location of the cervical varicosities. expanding uterus in pregnancy [6]. In the literature, only 17 cases of nifedipine and received betamethasone for fetal lung maturity. A cervical varicosities have been reported. Due to the rare nature of repeat TVUS performed by Maternal Fetal Medicine (MFM) at 33w3d • Cesarean section for cervical varicosities in the setting of cervical varicosities in pregnancy, proper management has not been confirmed cervical varicosities on the posterior wall of the cervix and abnormal placental implantation, especially placenta established. Management of antepartum bleeding has required in the cul-de-sac measuring 3.0x2.1x2.8 cm. According to MFM, the previa, may ensure control of postpartum hemorrhage. blood transfusions and placement of vaginal packings, cerclages, passage of the fetal head would compress the cervical varicosities on and Bakri balloons [1-3, 7-17]. Reported maternal and neonatal the posterior wall and minimize intrapartum bleeding. Therefore, MFM ▪ In our case, the cervical varicosities were in the posterior outcomes include preterm delivery, emergency cesarean sections, recommended a vaginal delivery in contrast to a cesarean section. cervix, which likely contributed to a successful and hysterectomy [7-8,10,12,15]. This is the rare case of a She was induced at 38w0d utilizing oxytocin. In preparation for a spontaneous vaginal delivery without a postpartum Caucasian 18-year-old G2P0101 diagnosed with cervical postpartum hemorrhage, 4 units of packed RBCs were prepared, and varicosities. Despite experiencing vaginal bleeding and contractions an interventional radiology consult was placed for possible hemorrhage due to compression by the fetal head. requiring a blood transfusion and tocolytics, she underwent a embolization. She underwent a spontaneous vaginal delivery. One ▪ Spontaneous vaginal deliveries in cases of cervical spontaneous vaginal delivery with no complications. This rare case small posterior vaginal wall laceration was repaired. No cervical varicosities without abnormal placenta implantation may of cervical varicosities emphasizes the need to establish lacerations or continuous active bleeding from the cervix were management guidelines for cervical varicosities in pregnancy. visualized. There was no postpartum hemorrhage. Her total calculated decrease the occurrence of postpartum hemorrhages. blood loss at delivery was 400 cc and there was no significant vaginal bleeding in the postpartum period. Her hemoglobin dropped Introduction appropriately from 9.7 to 8.8 upon discharge. REFERENCES Brown III JV, Mills MM, Wong H, Goldstein BH. Large volume cervical varix bleeding in a gravid patient. Gynecologic Oncology Reports Though rare, the majority of occurrences of cervical varicosities in 4(2013) 20-22 CDC. Severe Maternal Morbidity in the United. 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