What are the implications of a cervical polyp (cervical polypoid lesion) during pregnancy?

From the Guidelines

Cervical polyps during pregnancy should be monitored rather than removed unless they cause significant symptoms or complications, as recommended by the most recent guidelines 1. When a cervical polyp is discovered during pregnancy, the approach is typically watchful waiting, as these growths are usually benign and may regress on their own.

Key Considerations

• Removal of the polyp is only considered if there is heavy bleeding, recurrent infections, or concern for malignancy, as stated in the ACR Appropriateness Criteria for second and third trimester vaginal bleeding 1.
• The procedure, if necessary, is usually performed during the second trimester when risks of pregnancy complications are lowest.
• Local anesthesia may be used, and the polyp is typically removed by twisting it at its base or using electrocautery.
• Antibiotics are not routinely prescribed unless there are signs of infection.
• The removed tissue should always be sent for pathological examination to rule out malignancy, though cancer is rare in cervical polyps, as noted in the evaluation of vaginal bleeding in pregnancy 1.

Monitoring and Outcomes

• Regular prenatal check-ups should continue to monitor for any recurrence or complications.
• Most women with cervical polyps during pregnancy have normal pregnancy outcomes, as these growths rarely interfere with labor or delivery.
• The presence of polyps may be related to hormonal changes during pregnancy that cause increased vascularity and growth of cervical tissue, which can be evaluated using transvaginal US, as recommended for cervical-related causes of second and third trimester vaginal bleeding 1.

From the Research

Implications of Cervical Polyps During Pregnancy

• Cervical polyps during pregnancy can be managed with the aid of ultrasound, which helps in assessing the type of polyp and source of symptomatology 2.
• The presence of decidual polyps is associated with a higher risk of spontaneous abortion and preterm delivery compared to endocervical polyps 3.
• Polypectomy during pregnancy may increase the risk of miscarriage and preterm delivery, especially if the polyp is large (≥12 mm) or if there is bleeding before the procedure 4.
• Cervical cerclage may be effective in cases with a shortened cervical length and decidual polyp, but polypectomy should be avoided during pregnancy due to the risk of miscarriage 5.

Risk Factors for Preterm Delivery and Miscarriage

• Risk factors for preterm delivery and miscarriage include:
  • Presence of decidual polyps 3
  • Polyp width ≥12 mm 4
  • Genital bleeding before polypectomy 4
  • Polypectomy at ≤10 weeks 4
  • History of preterm delivery 3

Diagnosis and Management

• Hysteroscopy can be useful in managing cervical polyps, especially in cases with abnormal uterine bleeding, to make an accurate diagnosis and offer appropriate treatment 6.
• Ultrasound can help localize the source of symptomatology and determine the origin and type of polyp, allowing for an individualized treatment plan during pregnancy 2.