Pregnancy-Induced Isolated Severe Vaginal Varicosities: A Case Report and Literature Review

TL;DR

This case report describes a rare condition of severe vaginal varicosities during pregnancy and their management through cesarean delivery.

Contribution

The paper adds a new clinical case to the limited literature on vaginal varicosities during pregnancy.

Findings

A primigravida presented with large prolapsing vaginal varicosities at 36 weeks of gestation.

The varicosities resolved after cesarean delivery, with complete resolution by postoperative day 22.

Expectant management was used during pregnancy due to the lack of established guidelines.

Abstract

During pregnancy, total blood volume increases by about 40%. As gestation advances, blood volume to the pelvic region increases significantly. Due to the enlarging uterus, the venous return from the lower body decreases with advancing gestational age. The pooling and stasis of blood in the lower body can lead to the formation of varices, affecting the lower extremity, vulva, and vaginal regions. Varicosities in the lower extremities and vulva are not uncommon and often asymptomatic. Vulvar varicosities are more common in women with varicosities in the lower extremities. On the other hand, vaginal varicosities are extremely rare and mentioned only in case reports. Although asymptomatic, vaginal varicosities could become a concern for hemorrhage risk during vaginal delivery. There is little information in the current medical literature about the diagnosis and management of large vaginal varicosities during pregnancy.

Design We present a case of a primigravida with very large prolapsing vaginal varicosities that presented as a large external mass at 36 weeks of gestation.

The patient was managed expectantly during the antenatal period. She was delivered via an elective scheduled cesarean section. An almost complete resolution of the vaginal varices was noted at 6 hours postoperatively, with complete resolution reported on postoperative day 22.

Due to the rarity of the condition, we hope to add our experience to the literature.

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