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Uterine varices during pregnancy

Koji Matsuo, MD; Tadashi Kimura, MD, PhD

CASE NOTES

A 39 year old multiparous woman was prepared

for a cesarean section, as indicated for placenta
previa centralis with breech presentation of the
fetus. As soon as the uterus was exposed, it was
evident that the uterine venous plexus was ex-
tremely distended over the anterior surface of
the lower uterine segment. The patient had de-
nied any medical complications, including ab-
normal vaginal bleeding, and overall, her prena-
tal course had been uneventful. Her obstetrical
history included previous cesarean section with
classical uterine incision for delivery of a fetus in
transverse lie presentation.
An extremely distended uterine venous plexus was visualized over the
anterior surface of the lower uterine segment.

CONCLUSIONS

From the Department of Obstetrics and
Gynecology, Osaka University, Osaka, Japan
(Drs Matsuo and Kimura), and the
Department of Obstetrics, Gynecology, and
Reproductive Sciences, University of
Maryland School of Medicine, Baltimore,
MD (Dr. Matsuo).
Cite this article as: Matsuo K and Kimura T. Uterine
varices during pregnancy. Am J Obstet Gynecol 2007;
197;112.e1.
0002-9378/$32.00
© 2007 Mosby, Inc. All rights reserved.
doi: 10.1016/j.ajog.2007.05.010
Severe varices of the uterine venous plexus
were discovered in the lower uterine seg-
ment. This finding required the surgeons
to weigh their options for uterine incision
before surgery could continue. Because an
incision in the lower uterine segment
could have resulted in hemorrhage, a
transverse incision was made in the uterine
corpus to prevent bleeding from the swol-
len blood vessel. Immediately after deliv-
ery of the fetus and placenta, the varices
resolved. The patient’s estimated blood
loss was 760 mL.
Cervical varices, which are related to
placenta previa, can lead to life-threaten-
ing hemorrhage during pregnancy.1 The
large varices we suddenly encountered in
our patient’s lower uterine segment
could be a subtype of cervical varices and
as such, might be related to the abnormal
vasculature typical of placenta previa. In
addition, our patient’s history of classical
cesarean section may have contributed
to the development of uterine surface
varices. In general, surgeons should be
aware that patients whose pregnancies
are complicated by placenta previa are at
risk of varices of the uterine venous
plexus as well as cervical varices.2 f
REFERENCES
1. Yoshimura K, Hirsch E, Kitano R, Kashimura
M. Cervical varix accompanied by placenta pre-
via in twin pregnancy. J Obstet Gynaecol Res
2004;30:323-5.
2. Hashimoto K, Tabata C, Ueno Y, Fukuda H,
Shimoya K, Murata Y. Spontaneous rupture of
uterine surface varicose veins in pregnancy: a
case report. J Reprod Med 2006;51:722-4.

112.e1 American Journal of Obstetrics & Gynecology JULY 2007