Surgical management of endocervical and decidual polyps during pregnancy: systematic review and meta-analysis

Abstract

Purpose To evaluate the impact of endocervical and decidual polypectomy on obstetrical outcomes of pregnant women. Methods MEDLINE, Scopus, ClinicalTrials.gov, Scielo, EMBASE, Cochrane Library at the CENTRAL Register of Controlled Trials, and LILACS were searched from inception to April 2021. No language or geographical restrictions were applied. Inclusion criteria regarded observational studies concerning pregnant women with a cervical lesion who underwent cervical polypectomy. Co-primary outcomes were incidence of late pregnancy loss and preterm birth in women with endocervical or decidual polypectomy as well as polypectomy versus expectant management. Random effect meta-analyses to calculate risk ratio (RR) with 95% confidence interval (CI) were performed. Quality assessment of included papers was performed using Newcastle–Ottawa Scale criteria. Results Three studies, with data provided for 3097 women, were included in quantitative analysis, with comparisons between endocervical and decidual polyps extracted from two studies and 156 patients. After a first trimester endocervical or decidual polypectomy, no significant differences were found for late pregnancy losses (RR 0.29 [95% CI 0.05, 1.80], I2 = 11%). Risk for preterm birth was significantly higher for decidual polyps’ removal (RR 6.13 [95% CI 2.57, 14.59], I2 = 0%). One paper compared cervical polypectomy vs expectant management, with increased incidence of late pregnancy loss (4/142 vs 5/2799; p < 0.001) and preterm birth (19/142 vs 115/2799; p < 0.001) in women subjected to polypectomy. Conclusions Evidence regarding the removal of cervical polyps in pregnancy is extremely limited. However, the removal of either decidual or endocervical polyps seems associated with increased risk of pregnancy loss and preterm birth, with increased preterm birth risk following endocervical rather than decidual polypectomy.

The efficacy and safety of trans-vaginoscopy cervical polypectomy during pregnancy

“…Therefore, we believe that cervical polyps with recurrent symptoms or malignant presentation should be removed during pregnancy, while polypectomy itself carries a minimal risk for an sophisticated hysteroscopy doctor. Actually, it currently remains vague whether cervical polyps during pregnancy should be removed, there are no standardized guidelines to answer this question [12]. It is no doubt that cervical polyps should not be preferred to polypectomy when they were diagnosed.…”

The Autogenous Coelenterate-Endocervical Polyp Uterine Cervix

“…decidual alterations demonstrate heterologous elements as adipose tissue, cartilage, bone or glial tissue, possibly representing retained foetal tissues from preceding gestation. Exceptionally, endocervical polyp may harbour foci of in situ or invasive squamous or glandular lesions, as denominated by High Grade Squamous Intraepithelial Lesion (HSIL), adenocarcinoma in situ, squamous cell carcinoma or adenocarcinoma [1][2][3][4][5] (Figure 1 and 2). TNM staging of carcinoma cervix 2021 as per American Joint Committee on Cancer (version 9) [3,4].…”

Perinatal Outcomes in Women With Endocervical and Decidual Polyps During Pregnancy

“…Two main types of polyps are observed in the cervix during pregnancy: endocervical and decidual polyps (Riemma et al, 2023). Of these, endocervical polyps are the most common, and appear as proliferative lesions in the endocervical mucosa (Bornstein et al, 2012).…”

“…A meta-analysis of the surgical management of endocervical and decidual polyps during pregnancy (Riemma et al, 2023) revealed that there were no significant differences in late pregnancy losses in women who underwent endocervical or decidual polypectomy in their first trimester. However, the risk of preterm birth was significantly higher in women who underwent decidual polypectomy than in those who underwent endocervical polypectomy (relative risk, 6.13).…”