Risk factors for spontaneous miscarriage above 12 weeks or premature delivery in patients undergoing cervical polypectomy during pregnancy

Abstract

Background: It currently remains unknown whether the resection of cervical polyps during pregnancy leads to miscarriage and/or preterm birth. This study evaluated the risk of spontaneous PTB below 34 or 37 weeks and miscarriage above 12 weeks in patients undergoing cervical polypectomy during pregnancy. Methods: This was a retrospective monocentric cohort study of patients undergoing cervical polypectomy for clinical indication. Seventy-three pregnant women who underwent polypectomy were selected, and risk factors associated with miscarriage above 12 weeks or premature delivery below 34 or 37 weeks were investigated. A multivariable regression looking for predictors of spontaneous miscarriage > 12 weeks and PTB < 34 or 37 weeks were performed. Results: Sixteen patients (21.9%, 16/73) had spontaneous delivery at < 34 weeks or miscarriage above 12 weeks. A univariate analysis showed that bleeding before polypectomy [odds ratio (OR) 7.7, 95% confidence interval (CI) 1.6-37.3, p = 0.004], polyp width ≥ 12 mm (OR 4.0, 95% CI 1.2-13.1, p = 0.005), the proportion of decidual polyps (OR 8.1, 95% CI 1.00-65.9, p = 0.024), and polypectomy at ≤10 weeks (OR 5.2, 95% CI 1.3-20.3, p = 0.01) were significantly higher in delivery at < 34 weeks than at ≥34 weeks. A logistic regression analysis identified polyp width ≥ 12 mm (OR 11.8, 95% CI 2.8-77.5, p = 0.001), genital bleeding before polypectomy (OR 6.5, 95% CI 1.2-55.7, p = 0.025), and polypectomy at ≤10 weeks (OR 5.9, 95% CI 1.2-45.0, p = 0.028) as independent risk factors for predicting delivery at < 34 weeks. Polyp width ≥ 12 mm and bleeding before polypectomy are risk factors for PTB < 37 wks. Conclusions: Our cohort of patients undergoing polypectomy in pregnancy have high risks of miscarriage or spontaneous premature delivery. It is unclear whether these risks are given by the underlying disease, by surgical treatment or both. This study establishes clinically relevant predictors of PTB are polyp size> 12 mm, bleeding and first trimester polypectomy. PTB risks should be exposed to patients and extensively discussed with balancing against the benefits of intervention in pregnancy.

Cervical polyps in early pregnancy are a risk factor for late abortion and spontaneous preterm birth: A retrospective cohort study

“…The association between cervical polyps and chorioamnionitis or cervical polyps and preterm birth has already been reported. 4,5,17 cell count in mid-pregnancy and found that they were significantly higher in the cervical polyp group, and were lower after polypectomy. Furthermore, histopathological examination of the placenta indicated an association between cervical polyps and histological chorioamnionitis.…”

“…2,3 According to a cohort study on polyps removed during pregnancy, the rates of late abortion, spontaneous preterm birth (SPTB) before 34 weeks of pregnancy, and SPTB before 37 weeks of pregnancy were 6.8%, 15.1%, and 20.5%, respectively, which was higher than the general SPTB rate of 5.7% among pregnant women in Japan. 4 Histopathological examination of cervical polyps resected during pregnancy showed a higher rate of miscarriage and SPTB before 37 weeks of pregnancy in the decidual polyp group than in the endocervical polyp group. 5 Hence, although cases of resected cervical polyps have been reported, there have been no studies on the effect of cervical polyps on pregnancy outcomes compared with the non-polyp group or on the effect of cervical polyps including non-resected cases.…”

Investigation on Spontaneous Abortion and Human Papillomavirus Infection

“…Vaccines 2020, 8, 473 2 of 14 Factors affecting SA have not been completely elucidated [8,9]. Genetic abnormalities, including chromosomal alterations and/or abnormal chromosomal numbers, are accountable for about half of SA events [10][11][12].…”

Role of Ultrasound in Managing Cervical Polyps During Pregnancy

“…If resection is considered, there is a paucity of data on factors that can lead to complications. Fukuta et al have demonstrated an increased risk of complications from polypectomy if the width of the polyp is >12 mm, if gestational age is greater than 10 weeks, or if the patient is symptomatic with vaginal bleeding [ 9 ].…”