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Uterine Artery Embolization of Cervical Varices Before Second-Trimester Abortion

Lesko, Jennifer MD, MPH; Carusi, Daniela MD, MS; Shipp, Thomas D. MD; Dutton, Caryn MD, MS

Obstetrics & Gynecology:
doi: 10.1097/01.AOG.0000435449.01356.99
Case Report
Abstract

BACKGROUND: Cervical varices are an extremely rare complication of pregnancy; they can result in significant maternal morbidity secondary to acute hemorrhage. There is limited evidence to guide the management of cervical varices during termination of pregnancy.

CASE: A 37-year-old woman presented with recurrent vaginal hemorrhage at 17 weeks of gestation in the setting of a dichorionic–diamniotic twin gestation, an anterior placenta previa, a subchorionic hematoma visible on ultrasound examination, and prominent cervical varices. After extensive counseling, she and her husband opted for termination. Prophylactic uterine artery embolization was performed before uncomplicated laminaria placement and standard dilation and evacuation.

CONCLUSION: Prophylactic uterine artery embolization may have reduced hemorrhage risk from cervical varices during dilation and evacuation for second-trimester abortion.

In Brief

Uterine artery embolization may prevent bleeding from cervical varices during second-trimester termination of pregnancy.

Author Information

Department of Obstetrics and Gynecology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.

Corresponding author: Jennifer Lesko, MD, MPH, 1620 Tremont Street, 3rd Floor, Boston, MA 02120; e-mail: jel214@mail.harvard.edu.

Financial Disclosure The authors did not report any potential conflicts of interest.

© 2014 by The American College of Obstetricians and Gynecologists.