Severe Vulvovaginal Varicosities in Pregnancy
A 33-year-old woman was admitted for induction of labor at 41 weeks 3 days of gestation. This was her third full-term pregnancy, and she had received regular antenatal care. Before induction, the physical examination revealed venous varicosities on the right labia majora and minora and the right vaginal wall (Panel A). Varicose veins in both legs were also noted. The patient reported that the varicosities had developed several months earlier and caused increasing discomfort and pruritus, but she had been embarrassed to mention them. She had had smaller varicosities during her previous pregnancies, with normal vaginal delivery. Vulvovaginal varicosities are common in pregnancy and usually appear in the second trimester. Possible mechanisms include compression of the inferior vena cava by the gravid uterus and hormonal changes. The presence of vulvar varicosities is not a contraindication for vaginal delivery, but clinical discretion regarding the route of delivery is required, depending on the size and location of the varicosities. In this instance, the patient underwent caesarean delivery without complications. The vulvar varicosities were substantially smaller after delivery (Panel B).
