Sueyoshi Mark, Clevenger Steven, Hart Elaine
School of Medicine, University of California, Riverside, CA, USA.
College of Osteopathic Medicine, Western University of Health Sciences, Pomona, CA, USA.
Case Rep Obstet Gynecol. 2018 Jan 22;2018:2394695. doi: 10.1155/2018/2394695. eCollection 2018.
Pregnancy may cause the onset of vaginal or vulvar varicosities that may be a concern for hemorrhage risk during childbirth. A 38-year-old female G4P1112 at 34 weeks and 1 day was referred to an outpatient OB/Gyn clinic for evaluation of a large vaginal mass. The referring provider had concern for malignancy. Lesions of the vulva were biopsied and found to be benign. For two months prior to presentation, she was experiencing discomfort with walking, yellow vaginal discharge, and dysuria. Treatment with fluconazole showed no improvement. She denied any personal or family history of malignancies, varicosities, or hepatic issues. Past surgical history was significant for laparoscopic cholecystectomy and two cesarean sections. A large vaginal mass during pregnancy is a concern whether it is malignancy or large vaginal varicosities that may put the patient at risk of severe hemorrhage during childbirth. We concluded that the mass was large vaginal varicosities as there was no discernible etiology. A repeat cesarean section was recommended due to the risk of hemorrhage during childbirth. For long-term management, close observation postpartum was recommended. Spontaneous resolution is a potential outcome and this is what our patient experienced. Without an underlying etiology, supportive measures are the best options.
怀孕可能会导致阴道或外阴静脉曲张的出现，这可能会引起分娩时出血风险的担忧。一名38岁、孕4产1112、妊娠34周零1天的女性因一个大的阴道肿物被转诊至门诊妇产科诊所进行评估。转诊医生怀疑为恶性肿瘤。对外阴病变进行活检，结果为良性。在就诊前两个月，她走路时感到不适，有黄色阴道分泌物，并且尿痛。使用氟康唑治疗未见改善。她否认有任何个人或家族恶性肿瘤、静脉曲张或肝脏疾病史。既往手术史包括腹腔镜胆囊切除术和两次剖宫产。孕期出现大的阴道肿物令人担忧，无论它是恶性肿瘤还是大的阴道静脉曲张，都可能使患者在分娩时面临严重出血的风险。我们得出结论，该肿物为大的阴道静脉曲张，因为没有可辨别的病因。由于分娩时出血风险，建议再次剖宫产。对于长期管理，建议产后密切观察。自然消退是一种可能的结果，我们的患者就经历了这种情况。在没有潜在病因的情况下，支持性措施是最佳选择。
