Hemorrhage from Varicose Veins of the Vagina in Pregnancy.
Grunebaum states that varicose veins of the vagina are quite frequent in pregnancy. The veins become increased in length as well as in width and become tortuous. They are found in from 25 to 75 per cent of all pregnant women according to different authors.
The cause of the varicosities is primarily the pressure of the gravid uterus on the hypogastric and iliac veins. Over-filling of the large intestine through constipation is also an important factor in producing this trouble.
The upright position in standing and working is a third factor. We must add an individual predisposition by weak-walled veins. These varices produce serious and even fatal bleeding at the time of labor. The author describes three cases of hemorrhage in labor observed by himself.
The indication is to empty the uterus as soon as possible when hemorrhage occurs, since it cannot be controlled. When the physician has found such varices in the vagina the patient should be made acquainted with the danger of bleeding, and should be instructed how to make pressure on the varix with wadding should hemorrhage occur when a physician cannot be reached easily.—Munch Med. Woch.
COMMENT.—As I have said elsewhere, if these cases are reported early I have not found it difficult to cure them in advance of the labor. Active specific astringent tonics are used internally and locally and the general condition of the patient is given much attention.
I do not believe vaginal varicosis is as common as the above foreign writer finds it. I doubt if ten per cent of our cases are so affected.