2016 Volume 64 Issue 1 Pages 35-39
Vaginal varices are common during pregnancy and are rarely troublesome during the perinatal period. However, we report a woman who presented with massive postpartum hemorrhage caused by the rupture of prominent vaginal varices. A 35-year-old primigravida woman was found to have extensive vaginal varices with a red color on the surface at 28 weeks of gestation. She delivered a healthy infant at term. Immediately after the delivery, massive hemorrhage from the torn varices occurred. We first tried surgical sutures, but bleeding points could not be clearly identified because of the massive hemorrhage. We performed vaginal gauze packing to reduce the bleeding. The estimated blood loss at delivery was 3,770ml. Two days after the delivery we removed the vaginal packing, but massive hemorrhage from the varices resumed immediately.The blood loss was approximately 2,000ml in a few minutes, and the vaginal packing was the only means to control the bleeding. Both seven and 21 days after the delivery, balloon occlusion of the bilateral common iliac arteries was performed, but sufficient hemostasis was not achieved and vaginal packing was performed again. Because vaginal hemorrhage slowly decreased during the packing, we started step-wise removal of the vaginal packing and performed complete removal on the 48th day of puerperium without notable hemorrhage. Although life-threatening postpartum hemorrhage caused by vaginal varices is very rare, the present case suggests the need for an appropriate indication to avoid vaginal delivery.
