Cervical polyp: evaluating the need of routine surgical intervention and its correlation with cervical smear cytology and endometrial pathology: a retrospective study

Approach to cervical polyps in primary care

OBJECTIVE

To provide primary care providers (PCPs) with an approach for diagnosing and managing endocervical polyps, detailing a procedural technique for cervical polypectomy and outlining key information on when to refer to a gynecologist.

SOURCES OF INFORMATION

This review and approach are based on the second author's clinical practice and available literature from 1994 to 2023.

MAIN MESSAGE

Cervical polyps are commonly asymptomatic and benign, but can cause intermenstrual and postcoital bleeding. Cervical polyps alone are unlikely to be associated with dysplasia or malignancy; routine Papanicolaou and human papillomavirus tests remain the most important factors in identifying cervical dysplasia. For symptomatic patients, the lack of available literature to guide PCPs can result in unnecessary referrals to gynecology, long wait times, and associated costs to the health care system. Symptomatic endocervical polyps can be easily and painlessly removed by primary care clinicians in office using a ring-forceps polypectomy technique.

CONCLUSION

Cervical polyps are common and generally do not require intervention if asymptomatic. Patients with cervical polyps should still participate in routine cervical cancer screening. Symptomatic cervical polyps in appropriate patients can be removed by PCPs and sent for histologic examination to avoid long wait times and unnecessary referrals to gynecology.

Clinical Performance and Safety of Cerviron® Vaginal Ovules in the Management of Symptomatic Cervical Lesions: A National, Multicentric Study

Background

Cervical ectropion is frequently associated with vaginal symptoms requiring therapeutic intervention. However, no scientific consensus has been reached regarding the use of local re-epithelialization therapy to prevent severe bleeding, wound inflammation, and infection of cervical lesions.

Objective

The aim of our study was to investigate the aspect of the cervix by colposcopy after a 3-month treatment with an intravaginal medical device in the context of postoperative care of the symptomatic ectropion. The study analyzed additional clinical parameters, such as the evolution of primary and secondary inflammation and the degree of cervical epithelialization as secondary objectives.

Methods

Our pilot study included 27 participants with symptomatic cervical ectopy, with or without an associated human papillomavirus infection. The treatment protocol consisted of the monthly delivery of the medical device intravaginally, during day 1 to day 15, with a total study duration of 3 months.

Results

The medical device had a positive impact on cervical epithelialization, in terms of aspect of the cervix returning to normal for 100% of the participants. Between study visits, it was observed that primary inflammation was reduced by 85.19%, whereas vaginal ulceration, colpitis, and leukorrhea were improved by 70.37%, 81.48%, and by 66.67%, respectively.

Conclusions

The degree of cervical epithelialization reflects how well the cervix has healed after an injury or infection. The device showed clinical performance in complete re-epithelialization after surgical procedures. Moreover, our study findings suggest that supportive treatment with this intravaginal medical device can be recommended for cervical wound healing in patients with human papillomavirus infection. ClinicalTrials.gov identifier: NCT04735718.

Analysis on pregnancy outcomes and risk factors of cervical polypectomy during the first and second trimester pregnancy

AIM

To evaluate the risk factors of miscarriage in patients attempted cervical polypectomy during the first and second trimester pregnancy.

METHODS

Pregnant women with singleton infants who underwent cervical polypectomy during the first and second trimester between January 2013 and May 2019 were investigated. The study retrospectively reviewed the clinical features and pregnancy outcomes after cervical polypectomy. A multivariable regression was performed to predict the risk factors of miscarriage.

RESULTS

A total of 307 pregnant females were eventually included in our study. Twenty-seven patients (8.8%, 27/307) had a miscarriage before 28 weeks, 37 patients (12.1%, 37/307) had a preterm delivery. After univariate analysis, we found that the presence of decidual polyps and vaginal bleeding after polypectomy were the risk factors for miscarriage. Moreover, the incidence of miscarriage was significantly higher in the patients with decidual polyps than in those with endocervical polyps (14.9% vs. 5.6%, p = 0.010).

CONCLUSIONS

The most suitable hemostasis method should be taken in the cervical polypectomy during pregnancy. The risk of miscarriage associated with polypectomy during pregnancy is higher in females with decidual polyps. If decidual polyps are highly suspected and they do not cause excessive vaginal bleeding and can be ruled out the possibility of malignancy, conservative treatment may lead to a better outcome.