Cervical varices: An unusual source of first‐trimester hemorrhage

Abstract

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

“…Notably, there is no evidence to suggest that this patient was exposed to DES in utero. Furthermore, several cases have reported twin dichorionic diamniotic gestation via in-vitro fertilization (IVF); a suggested correlation with cervical varices is that multifetal gestation presents with increased uterine size and increased pressure on the vena cava and pelvic vasculature [ 10 , 16 , 18 ]. The patient had a single gestation, without IVF.…”

“…In addition to the lower extremities, varicosities are also frequently found in the hemorrhoidal plexus as well as the vulva and perivulvar veins; specifically, about 15% of pregnancies are complicated by vulvar varicosities [ 4 , 5 ]. Cervical varicosities are extremely rare complications of pregnancies, and few cases have been reported [ 1 , [4] , [5] , [6] , [7] , [8] , [9] , [10] , [11] , [12] , [13] , [14] , [15] , [16] , [17] , [18] ]. These case reports document any associated medical conditions and discuss potential risk factors for the development of cervical varicosities.…”

Pessary for Management of Cervical Varices Complicating Pregnancy

“…It appears that physiologic hemodynamic changes that occur during pregnancy, including increased intravascular volume and compression of pelvic veins and inferior vena cava, might contribute to the production of cervical varices. 2,4,5,[7][8][9][10][11] Polyhydramnios and multiple pregnancies have been associated with cervical varices formation, probably due to the overdistension of the uterus, which exaggerates the compression of pelvic venous return. 7,8,10,12 In a PubMed literature search of the past 25 years using the terms "bleeding" or "hemorrhage" and "cervical varices" or "cervical varix" or "cervical varicosities" and "pregnancy" or "obstetric" or "maternal" and "pessary," we identified only 19 reported cases of cervical varices complicating pregnancy; in none of them was pessary used (Table 1).…”

“…2,4,5,7–11 Polyhydramnios and multiple pregnancies have been associated with cervical varices formation, probably due to the overdistension of the uterus, which exaggerates the compression of pelvic venous return. 7,8,10,12…”

“…Low placental implantation has been proposed to predispose varices formation by increasing venous drainage in to the cervical plexus. 1,3,4,7–12 Wax et al 7 describe a case that manifested the potential for variceal regression with resolution of the low-lying placenta with advancing gestation.…”