Perinatal management of intracervical-type varices without placenta previa

Intracervical-type varices, dilated venous structures extending from the lower uterine segment to the cervix, are sometimes observed on transvaginal ultrasonography and magnetic resonance imaging (MRI). This study aimed to evaluate the anatomical and clinical significance of these imaging findings and propose appropriate management strategies based on the results.

A retrospective analysis of 43 patients with intracervical-type varices diagnosed using MRI at our institution between 2019 and 2023 was conducted, excluding those with abnormal placental positioning. Maternal characteristics, bleeding patterns, delivery outcomes, hemostatic interventions, and transfusion requirements were assessed.

Spontaneous resolution occurred in two patients. Of the remaining 41, severe hemorrhage occurred in 20 (48.8 %) during delivery. Four planned vaginal deliveries required emergency cesarean sections due to antenatal bleeding. Among 16 cesarean deliveries, 10 (62.5 %) experienced blood loss exceeding 1,500 mL (mean: 2,339 ± 1,027 mL). Among 25 vaginal deliveries, 10 (40 %) exceeded 800 mL blood loss (mean: 2,035 ± 1,215 mL), with six spontaneous vaginal deliveries exceeding 1,000 mL, all requiring transfusion.

Intracervical-type varices, identifiable using transvaginal ultrasonography and MRI, pose a significant risk of antenatal bleeding and severe intrapartum hemorrhage. Anticipatory management, including autologous blood storage and tailor delivery planning, is crucial for optimizing maternal outcomes.