Recurrent Bleeding From Cervical Varices in Pregnancy: A Case Report and Literature Review

Cervical varices are a rare pregnancy complication that can result in recurrent or massive genital bleeding, posing a risk for preterm delivery. There is no established management strategy, and individualized treatment is required. A 32-year-old woman, gravida 5 para 0, with a bicornuate uterus and multiple uterine fibroids, was referred at 21 weeks and three days of gestation due to persistent vaginal bleeding. She was diagnosed with cervical varices associated with a low-lying anterior placenta. During a 15-week inpatient course, she experienced approximately 20 episodes of bleeding, some exceeding 1000 mL and requiring hemodynamic support. Each episode was successfully managed by direct gauze compression. A total of 30 units of red blood cells (RBCs) and six units of fresh frozen plasma (FFP) were transfused. At 36 weeks and three days of gestation, cesarean delivery was performed under spinal anesthesia, and a healthy male infant was delivered. The cervical varices regressed postoperatively and had resolved completely by one month postpartum. The conclusion is that gauze compression is an effective first-line approach for managing cervical variceal bleeding and can help prolong gestation in affected pregnancies.