Cervical Varices Presenting as Vaginal Bleeding: A Description of Two Cases and A Management Plan

Copyright: © 2015 Chyjek K. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. cervical varices found in the setting of second and third trimester bleeding, report on the clinical outcomes and propose a management plan. A 31-year-old, gravida 1 para 0 abortus 0, presented to her obstetrician at 15 weeks gestation timed by intrauterine insemination, complaining of severe abdominal cramping. Transabdominal ultrasound showed a single live intrauterine pregnancy and a low lying placenta. A complex echogenic area within the endocervical canal suggestive of a mucus plug was noted. Two days later, the patient experienced severe vaginal bleeding with passage of numerous blood clots with an estimated blood loss of 200 milliliters. Repeat imaging at that time revealed a hypoechoic area distending the endocervix to 1.5cm. Color and pulsed Doppler showed markedly increased vascularity indicative of cervical varices versus a venous angioma or other arteriovenous malformation (AVM). Active flow extended into the anterior body of the cervix, near the internal os and given the low velocity venous pressure, cervical varices were confirmed (Figure 1). There was no apparent placenta previa at this time. Although this acute bleeding episode resolved, the patient presented the following day to the emergency department with profuse, painless, bright red vaginal bleeding of approximately 600 milliliters. She remained hemodynamically stable with minimal change in hemoglobin. Conservative management with vaginal packing and observation was implemented. Sterile speculum exam revealed a 1-2cm dilated cervix with decreased bleeding and tortuous appearing vessels at the level of the internal os. No contractions were observed on tocometry. An emergent McDonald cerclage was placed and modified bed rest and pelvic rest was enforced. Follow-up ultrasound examinations Abstract Background: Varicose veins are common in pregnancy. However, potentially life-threatening uterine cervical varices have rarely been reported and there are currently no guidelines for their management.