Cervical Varicosities

My boy was concieved through Clomid and an IUI. At that moment, my RE was all up in my cervix, and nothing looked abnormal.

At 7 weeks pregnant, I had a bleeding episode that landed me in the ER. At that time they did a cervical exam, all good. The bleeding was due to a subchorionic hemorrhage.

At 13 weeks, my OB did my 12 week appt. She did a cervical check and asked if I had ever had surgery on my cervix. I hadn’t, and told her so. Nothing else came of it.

At 18.5 weeks, I woke up to bright red bleeding. We went to the OB, I had a cervical exam by a nurse practitioner who asked if I had ever had surgery on my cervix. I told her I hadn’t.  She asked if anyone had asked me that before, I told her Dr. T had asked me that at 13 weeks. And she said she was seeing something peculiar and wanted a second opinion. She called in Dr. T and she looked and said my cervix looked angry, but often times pregnancy can make a cervix angry. She suggested we get an u/s to make sure that my cervix wasn’t dilating or thinning. After the ultrasound, we met back with the the NP who told me the ultrasound revealed a subchorionic hemorrhage(again), a hematoma, a clot right above my cervix, and what appeared to be a varicose vein on my cervix. The NP told me it was no big deal, and that my pregnancy could continue as normal.

During weeks 19 my obs scheduler called me and told me my OB did want to see me for a colposcopy and perhaps a biopsy at 20 weeks 2 days. So 20 weeks at 2 days I went into my OBs. She put in the speculum, swabbed my cervix, and I started pouring blood. She stopped it to the point she felt comfortable with. She said she wasn’t able to do either the colposcopy of the biopsy bc of the bleeding. She wanted me to see an ob oncologist. She didn’t think it was cancer, but she wanted a second opinion. She wanted this second opinion sooner rather than later. Her first choice ob oncologist was booked out a month, so Dr. M at the university of Louisville. I had an appt scheduled for 21 weeks 2 days.

The next week after Dr.T’s attempt at a colposcopy, I bled, I gushed blood when bearing down to have a bowel movement. I gushed blood when I sneezed.

21 weeks 2 days we met with Dr.M. He told us immediately, he would take a look, but most likely he would not do a biopsy outside of the operating room. He looked at my with the smallest speculum, and pulled it out. He told us when he looked at my cervix, he couldn’t see the cervix, just this vascular thing. He wanted us to immediately go see Dr.W a MFM. We walked across the uofl medical campus.

Dr.W preformed a very thorough ultrasound. Which he concluded that this vascular thing is a varicose vein. He told me  he would discuss with Dr. M how to address this.

Together they decided a vaginal surgical approach would be best. In it, if there was just one varicose vein, they would put a stitch around it. They told me the main risk was bleeding, but there was a risk that our boy would come early. We debated waiting until viability, but ultimately, Dr.M informed us that true viability wouldn’t be until around 27.5 weeks, when the brain was done developing. And the risk of this thing rupturing was too high for us to wait. We decided to proceed with surgery Thursday August 28th at 21 weeks 5 days.

The surgery went well, my cervix was full of these varicosities, not just the one that they could see before hand. During the surgery one of the varicose veins ruptured, it only bled for about 3 seconds before the got a clamp on it, but Dr.M told us it was pouring like a faucet, he said had it ruptured at home, even if I managed to get to a hospital in 10 minutes, the blood loss would have been devastating. They stiched the outside varicosity and narrowed it down to where the blood flow through it is minute compared to what it was. For the cervix varicosities, they put a cerclage around.

After the surgery they packed my vagin with moist gauze over night. The next morning they removed it. Dr. We told me some bleeding was ok. It could even look like a medium to heavy flow of a period. If it is bright red blood coming out in gushes, I’m suppose to go back in. But anything other than that is fine.

I am off work for weeks, and have a vaginal ultrasound scheduled for 13 days from now, along with a followup with my normal OB.

2 weeks post op- had a followup with MFM. My cervix looks “much more normal” in the sense that on an ultrasound, my doctor can make out a cervix, where as before he wasn’t able to. I am “spotting” but it is minimal. If I didn’t have a vaginal ultrasound today, I likely wouldn’t have worn any sort of panty liner or anything. The vasculature is still there but a much more normal size. My cervix is 4.05 cm, which is great(a prematurely opening cervix is 2.5 cm I think.) The current plan is between 32-35 weeks(likely it’ll be 35 weeks bc they do group b strep test then) I will have a speculum exam. At that time the ywill probably remove the cerclage, and likely decide on method of delivery. He said if there is a chance that some really persistent varicosities could reappear in the next 11 weeks or so, but he doesn’t anticipate that happening. I am still on pelvic rest(:-() but I can work normally.

Dr. W is taking everything in steps. I will update as new things develop, but the hope now is I will be able to carry baby boy to term. There is a chance for a vaginal delivery, but I would say it is minimal due to the varicosities throughout my cervix.


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