Cervical Hemangioma In Pregnancy

Abstract

Hemangioma in the uterine cevix is a rare case, especially during pregnancy. Hemangioma is a benign tumor, but it can cause complication namely antepartum bleeding, preterm labour, and severe, life threatening complication such as disseminated intravascular coagulation (DIC). Histopathology examination is needed to diagnose hemangioma, and to differentiate this disease with other pathological condition. Conservative therapy was chosen as the main option rather than surgical therapy. The case report explain about 2 cases with cervical hemangioma in the uterine in 2 pregnant women. In the case 1 we presented a 27 years old primigravida, 29th weeks gestational age, with antepartum bleeding. A cervical biopsy was done and the histopathological examination reveal a capillary hemangioma within the uterine cervix. The patient was followed up with medications, and a caesarean section was planned to deliver the baby. In the case 2, a 30 years old multigravida with complained of postpartum bleeding. The clinical manifestation of cervical hemanioma in pregnancy was similar with other pathological condition, such as cervical cancer. A better understanding in pathogenesis and histopathological examination is important to differentiate hemangioma and other pathological condition in uterine cervix. Therapeutic modality was still debated, because of the limitation of literature about hemangioma cervix, especially in pregnant women

A rare case report of cervical hemangioma and a comprehensive literature review of 137 cases of cervical and uterine hemangiomas

“…Invasive approaches such as hysterectomy are considered for refractory cases, atonia or DIC conditions 5,9 . In the setting of pregnancy, cesarean section is the preferred method for managing delivery to prevent acute bleeding following injury of the hemangioma 5,8,14 .…”

“…6 Other angiogenic factors that increase with estrogen are the basic fibroblast growth factor, insulin-like growth factor, and transforming growth factorβ. 5 Cervical hemangiomas can be acquired or congenital. 9 Most cases are acquired and are associated with tissue injury, hypoxia, curettage, and hormonal alteration.…”

“…Invasive approaches such as hysterectomy are considered for refractory cases, atonia or DIC conditions. 5,9 In the setting of pregnancy, cesarean section is the preferred method for managing delivery to prevent acute bleeding following injury of the hemangioma. 5,8,14 Vaginal delivery can be performed under limited circumstances, including no signs of a rapid increase in size, anatomical distortion, obstruction of the delivery canal, and bleeding.…”

“…The manifestation of hemangiomas in the FGT may vary widely, from asymptomatic benign tumors, due to small sizes, that are found incidentally to overt abnormal uterine bleeding, postpartum hemorrhage, dyspareunia, and postcoital bleeding 3 . Additionally, infertility, respiratory distress syndrome in newborns, and maternal or fetal demise as a result of heavy bleeding have been reported as less frequent but fatal complications of FGT hemangiomas 4,5 …”

“…respiratory distress syndrome in newborns, and maternal or fetal demise as a result of heavy bleeding have been reported as less frequent but fatal complications of FGT hemangiomas. 4,5 Although hormonal disturbances, especially during pregnancy, are known to be a leading cause of vaginal and cervical hemangiomas, 6 asymptomatic cases found incidentally, regardless of pregnancy status, should not be neglected. 4 In the present study, we describe a postmenopausal woman with an asymptomatic cavernous hemangioma of the uterine cervix diagnosed histologically.…”