title: Vaginal delivery in the presence of huge vulvar varicosities: a case report with MRI evaluation.
abstract: Vulvar varicosities are generally not an indication for a caesarean section but in a rare case of severe vulvar varicosities, it would be a controversial issue whether to perform a caesarean section for fear they might rupture during a vaginal delivery. We present a case of huge vulvar varicosities during pregnancy. MRI revealed obstruction of the internal iliac system by the gravid uterus and subsequent incompetence of a collateral pathway via the round ligament vein that emptied into the ovarian vein. The patient went into labour at 38 weeks, and successfully vaginally delivered a baby. The vulvar varicose veins became compressed by the foetal head from the inside, and markedly diminished in size during crowning and after delivery. Women with vulvar varicosities can be allowed to attempt a vaginal birth regardless of their severity. The use of MRI aids in the overall anatomical understanding of vulvar varicosities in pregnancy.
authors.affiliation: Department of Gynaecology and Obstetrics, Kyoto University, Kyoto, Japan.
authors.forename: Nozomi
authors.initials: N
authors.lastname: Furuta
authors.forename: Eiji
authors.initials: E
authors.lastname: Kondoh
authors.forename: Shigehito
authors.initials: S
authors.lastname: Yamada
authors.forename: Kaoru
authors.initials: K
authors.lastname: Kawasaki
authors.forename: Akihiko
authors.initials: A
authors.lastname: Ueda
authors.forename: Haruta
authors.initials: H
authors.lastname: Mogami
authors.forename: Ikuo
authors.initials: I
authors.lastname: Konishi
mesh_terms: D000328:Adult; D036861:Delivery, Obstetric; D005260:Female; D006801:Humans; D018810:Magnetic Resonance Angiography; D049590:Postpartum Period; D011247:Pregnancy; D011249:Pregnancy Complications, Cardiovascular / Q000503:physiopathology*; D011262:Pregnancy Trimester, Second; D011263:Pregnancy Trimester, Third; D012075:Remission, Spontaneous; D012720:Severity of Illness Index; D047929:Term Birth; D014648:Varicose Veins / Q000503:physiopathology*; D014844:Vulva / Q000098:blood supply*