A 35-year-old pregnant woman gravida 2 para 1 (previous NVD (normal Vaginal Delivery)), at 22 weeks of gestational age, presented to an academic hospital with a history of fresh heavy, and painless vaginal bleeding. The patient was in stable but pale condition. Her vital signs were normal, but only her heart rate (HR) was slightly elevated (HR: 103/BP (blood pressure):100/70/RR (respiratory rate):16 /SO2:98 %). She did not complain of abdominal pain or uterine contractions. She only complained of occasional dizziness and headache but did not mention other poor signs such as nausea, vomiting, blurred vision, or diplopia. At the time of arrival, tocometry was reassuring (no pain was detected), and the performed speculum examination showed the bleeding at the spotting level. The patient had a history of frequent vaginal bleeding that often occurred after defecation. Two occasions of these bleeding episodes had led to the reception of packed cells. The first time was at 14 weeks of gestational age with hemoglobin of 6.8 g/dL and the second time was at 18 weeks of gestational age with hemoglobin of 7 g/dL. On both occasions, the patient was discharged after receiving two packed cells with hemoglobin of about 9 g/dL and controlling bleeding. On another note, the patient's previous pregnancy ended without any problems at 40 weeks of gestational age. In the ultrasound performed at the hospital, the placenta was previa, but no traces of hematoma behind the placenta were seen (). In the transvaginal sonography (TVS), hypoechoic areas were in favor of varicose veins, and fully active vessels were observed in the cervix region, especially in the anterior lip, which continued to the endocervix (). In the transverse section, the vessels were completely stretched to the circumference of the cervix (). Therefore, it was not possible to perform cerclage for the patient. Also, the color Doppler sonography showed us that the venous flow is flowing in the varicose veins of the cervix (). In addition, the myometrium line behind the placenta was clear, there were no abnormal vessels or lacuna in the placenta. Finally, the patient was diagnosed with cervical varices according to both transvaginal and Doppler ultrasonography. She was observed and anti-constipation treatment was prescribed for her. Furthermore, the patient was prevented from having sexual intercourse and any heavy work, so that she did not experience any frequent bleeding. Due to the possibility of an emergency cesarean section (C/S), 12 mg of betamethasone and Magnesium Sulfate (4 g loading over 20 min and the maintenance dose of 1 g/h/12 h) were given at the appropriate time for the development of the fetal lung and neuroprotection. After that, she underwent an elective cesarean section at 37 weeks of gestational age due to the prevention of rupture of cervical varices at NVD. Also, the hysterectomy specimen was sent for histopathology and the result was dilated and tortuous cervical vessels without any findings suggesting a morbidly adherent placenta. A female infant weighing 3400 g was delivered, with Apgar scores of 9 and 10 at 1 and 5 min. Extraordinary bleeding shortly after delivery happened from the varroosis of the cervix and the lower part of the uterus; the estimated blood loss was 2000 ml. The uterus was contracted and 1 g Tranexamic acid was injected intravenous, and immediately bilateral uterine artery occlusion and compression stitches in the lower uterine segment were done, although due to ongoing blood loss and failure to respond to conservative management. She underwent a total hysterectomy since the bleeding could not be controlled using compression stitches or medications to make the uterus contract. In addition, she received 4 units of packed cells, 2 units of FFP (Fresh frozen plasma), 2 units of PLT (platelets), 2 g of fibrinogen, and 2 g of Tranexamic acid during the cesarean section. The laboratory evaluation after the operation showed hemoglobin from 12.7 to 12.4 (g/dL). Also, Iron tablets were prescribed for her (200 mg/daily). She was discharged with no problem. At her follow-up visit one month after discharge, she appeared well, her anemia had resolved, and she continued exclusively breastfeeding.