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

Role of surgical vaginoscopy through no-touch hysteroscope in the treatment of female reproductive polyps

BACKGROUND

The study aims to investigate the application of surgical vaginoscopy via a no-touch hysteroscopic approach for the management of female genital polyps. The primary objective is to assess the feasibility of this technique in treating intrauterine pathologies in both pregnant and non-pregnant women.

METHODS

A total of forty-six patients diagnosed with genital polyps underwent operative vaginoscopy at a university-affiliated hospital between April 1, 2017 and May 31, 2023. A retrospective analysis was conducted on the collected data, encompassing patient complaints, clinical presentations, surgical outcomes, and pathological diagnoses. Additionally, the success rate of the vaginoscopic procedures was determined.

RESULTS

Forty-six patients with an average age of 33.0 ± 8.8 years were included in this study. Among them, 25 were non-pregnant (3 with and 22 without a sexual history). The most common clinical manifestation was irregular vaginal bleeding (11/25, 44%) followed by conscious vaginal protrusion (10/25, 40%). Among the 21 pregnant patients, the main symptom was irregular vaginal bleeding during pregnancy (100%). The postoperative pathological diagnoses included 11 endometrial polyps, 33 cervical polyps, 1 multiple vaginal polyps, and 1 vaginal stump polyps. The coincidence rate between the intraoperative vaginoscopic diagnosis and postoperative pathological diagnosis was 100%. Among the non-pregnant patients, 11 were diagnosed with endometrial polyps, with an average length of 2.2 ± 1.2 cm, 1 patient had vaginal residual polyps after total hysterectomy, with a polyp length of 0.3-0.7 cm, and 1 had multiple vaginal polyps, with a length of 0.5-3 cm. Twelve patients had cervical polyps with an average length of 3.4 ± 1.2 cm. Twenty-one pregnant patients were diagnosed with cervical polyps, the average length of 2.4 ± 1.4 cm. All patients successfully underwent vaginoscopic surgery, for an average surgical duration of 23.5 ± 14.9 min, a bleeding volume of 1-10 mL(4.5 ± 3.4 mL), and an average hospitalisation of 2.7 ± 1.3 days. Throughout the surgical procedures, no complications were encountered, including water intoxication or uterine perforation. Postoperatively, no patients experienced discomforts such as fever or moderate to severe abdominal pain. Furthermore, all non-pregnant women were monitored for a two-month period following surgery, and throughout this interval, there were no reports of abnormal vaginal bleeding, unusual vaginal discharge, or abdominal pain. None of the 21 pregnant women experienced abnormal vaginal bleeding after the surgery. Nineteen of them delivered at full term, and one underwent caesarean delivery at 31 weeks owing to placental abruption. All the newborns had Apgar scores of 10, 10, and 10, and one had a miscarriage at 18 weeks of gestation.

CONCLUSION

Vaginoscopic surgery through no-touch hysteroscope represents a minimally invasive and highly effective method for addressing female reproductive tract polyps. This approach holds significant clinical value, particularly in the management of cervical polyps during pregnancy.

The efficacy and safety of cervical polypectomy with vaginoscopy in pregnant women

PURPOSES

This study aims to assess the effectiveness and safety of cervical polypectomy performed via vaginoscopy in pregnant women.

METHODS

Pregnant patients diagnosed with cervical polyps were retrospectively included in Beijing Tiantan Hospital between April 2017 and April 2023. Group A underwent cervical polypectomy using a vaginoscopy technique without speculum, cervical forceps and anesthesia, while Group B received conservative management. The incidence of spontaneous abortion, preterm birth, preterm rupture of membranes (PROM), visual analog scale (VAS) scores, timing and method of delivery, and neonatal outcomes were analyzed.

RESULTS

Of 90 pregnant patients included in the study, 48 patients receiving polypectomy under vaginoscopy were included into group A while 42 patients receiving conservative treatment were assigned into group B. At baseline, group A exhibited higher rates of vaginal bleeding pre-operation, as well as larger cervical polyp dimensions compared to group B. The median interval between vaginal bleeding and polypectomy was 3.5 weeks, with the median procedure typically performed at gestational week 19 in group A. There was no significant difference in the incidence of spontaneous abortion between the two groups (4.2% vs. 4.8%, p = 1.000). However, group A showed a significantly lower frequency of preterm birth (4.2% vs. 21.4%, p = 0.030) and premature rupture of membranes (PROM) (18.8% vs. 45.2%, p = 0.025) compared to group B. No disparities were observed in the timing, mode of delivery, and neonatal outcomes between the two groups.

CONCLUSIONS

The utilization of vaginoscopy for cervical polypectomy has been shown to decrease the likelihood of preterm delivery and premature rupture of membranes in pregnant women with symptomatic cervical polyps. Therefore, performing cervical polypectomy via vaginoscopy without anesthesia provide a feasible and optimal ways in the management of this population.

Pregnancy and Adverse Obstetric Outcomes After Hysteroscopic Resection: A Systematic Review and Meta-Analysis

Objective

Although the randomized controlled trial (RCT) of the efficacy of hysteroscopic resection in women with uterine septum has not shown any significant correlation in recent research, motivation for deeper study remains insufficient. In this study, the objective was to determine pregnancy-related outcomes, along with adverse obstetric outcomes, following hysteroscopic resection and also to determine whether women with hysteroscopic resection bear the same outcomes as women with normal uterine cavities.

Search Methods

From January 1995 to February 2022, a systematic literature review was conducted to identify all studies published concerning the gestation outcomes of women with and without hysteroscopic resection while comparing the gestation outcomes of women after hysteroscopic resection and with a normal uterine cavity. Our primary outcome was the live birth rate (LBR). The secondary outcomes were term delivery, preterm delivery, spontaneous miscarriage, malpresentation, cesarean section, and other adverse obstetric outcomes.

Results

22 studies were included in this meta-analysis. The control groups of 14 studies were treated women, and the control groups of the other 8 studies were patients bearing a normal uterine cavity. Hysteroscopic resection was related to a higher rate of term delivery (OR = 2.26, 95% CI, 1.26–4.05), and a lower rate of spontaneous abortion (OR = 0.50, 95% CI, 0.27–0.93), and a lower rate of malpresentation (OR = 0.31, 95% CI, 0.19–0.50). Nevertheless, in comparison with the normal uterus group, the rates of preterm birth, cesarean section, and postpartum hemorrhage after resection did not return to normal levels.

Conclusion

Hysteroscopic resection can effectively reduce the risk of abortion and malpresentation in patients possessing a uterine septum while increasing the term delivery rate. Although well-designed RCTs should confirm our meta-analysis, it still bears recommending to patients