2 months pregnant, cervical decidual polyps found

Cervical cancer is a common disease in the female uterus, but because its symptoms are not particularly obvious, some women do not even realize that they have this disease. So some women accidentally discovered that they had cervical decidual polyps during a gynecological examination two months after pregnancy. What should they do at this time?

Endometrial polyps are common gynecological diseases caused by local excessive proliferation of the endometrium. They appear as single or multiple smooth tumors protruding into the uterine cavity with pedicles of varying lengths. It can cause irregular vaginal bleeding and infertility. Women from childbearing age to postmenopause are at high risk of endometrial polyps. The cause of the disease is currently unknown, but it is believed to be related to endocrine disorders. Ultrasound diagnosis is the main method, and intrauterine acoustic angiography has a higher sensitivity. Hysteroscopy is the gold standard for diagnosing endometrial polyps, and hysteroscopic polypectomy is the preferred treatment for endometrial polyps, but polyps are prone to recurrence. Endometrial polyps may occasionally become malignant, especially in postmenopausal women with vaginal bleeding. When polyps show atypical hyperplasia, they should be regarded as precancerous lesions.

Causes

1. Endocrine factors

Because estrogen can promote the proliferation of the endometrium and produce menstruation, the formation of endometrial polyps is closely related to excessively high estrogen levels. Perimenopausal and postmenopausal hormone replacement therapy, and regular consumption of hormone health products, will increase the estrogen level in women.

2. Inflammatory factors

Long-term gynecological inflammation, foreign bodies in the uterine cavity (such as contraceptive rings), childbirth, miscarriage, postpartum infection, surgical operations or mechanical stimulation may all cause the occurrence of endometrial polyps, and long-term inflammation will make the polyps larger and larger.

3. Others

Aging, hypertension, obesity, diabetes, and long-term use of tamoxifen after breast cancer surgery are all high-risk factors for endometrial polyps.

Clinical manifestations

This disease can occur at any age after puberty, but is more common in women over 35 years old. Single, small endometrial polyps often have no clinical symptoms and are often discovered during gross examination after hysterectomy for other diseases or during diagnostic curettage. Some patients may experience menorrhagia and prolonged menstruation, which is related to the increase in endometrial area and excessive endometrial hyperplasia. Large polyps or polyps that protrude into the cervical canal are prone to secondary infection and necrosis, causing irregular bleeding and foul-smelling bloody secretions.

1. Irregular uterine bleeding

Excessive and prolonged menstruation or abnormal uterine bleeding before menopause, but the severity of symptoms is not related to the number, diameter and location of polyps.

2. Abdominal pain

It usually starts in the second half of the menstrual period, progressively worsens, and gradually disappears after the menstrual period ends. It is mainly due to the obstruction of endometrial polyps, which leads to poor menstrual blood discharge.

3. Abnormal leucorrhea

A small number of patients with larger polyps may experience increased leucorrhea or blood in the leucorrhea, or contact bleeding, which is especially prone to bleeding after sexual intercourse and when squatting and straining to defecate.

4. Infertility

If endometrial polyps grow in the cervical canal, they may hinder the entry of sperm into the uterine cavity; if they grow in the uterine cavity, they will hinder the implantation of the fertilized egg or affect the development of the embryo, thus leading to infertility.

examine

1. Gynecological examination

If the uterus is slightly larger, such as if the pedicle of an endometrial polyp is long, the growth can be seen or felt at the cervical opening.

2. Ultrasound examination

Transvaginal ultrasound examination shows a regular shaped hyperechoic lesion in the uterine cavity, surrounded by a weak hyperechoic halo. The results of examination during the proliferative phase of the menstrual cycle are more reliable. Repeating ultrasound after the menstrual period is over can help distinguish "polypoid endometrium" from endometrial polyps. Intrauterine sonosonography has higher sensitivity and specificity.

3. Hysteroscopy

Hysteroscopy can not only observe the situation inside the uterine cavity under direct vision, which is intuitive and clear, but also remove tissue for pathological examination. It is an important method for diagnosing endometrial polyps.

4. Pathological examination

The most common type is a localized endometrial tumor protruding into the uterine cavity, single or multiple, with a diameter ranging from a few millimeters to several centimeters, and a pedicle of varying thickness and length. The surface of the polyp often has hemorrhagic necrosis and may also be infected. If the pedicle is twisted, hemorrhagic infarction may occur.

Pathological examination shows that endometrial polyps are composed of endometrium, with the surface covered by a layer of cuboidal epithelium or low columnar epithelium. The middle part of the polyp forms a fibrous longitudinal axis, which contains blood vessels.

diagnosis

A preliminary diagnosis can be made based on the patient's symptoms, gynecological examination, and ultrasound examination. The diagnosis can be confirmed by taking the diseased tissue for pathological examination under hysteroscopy guidance. Pay attention to differentiate it from submucosal uterine fibroids, endometrial cancer, etc.

treat

1. Conservative treatment

For small, asymptomatic polyps, no intervention is required temporarily. Some polyps may resolve spontaneously. Drug treatment of polyps is not recommended.

2. Hysteroscopic transurethral resection

For patients with obvious clinical symptoms, those who have been found to have growths in the uterine cavity by B-ultrasound, or those whose intrauterine growths cannot completely rule out the possibility of malignancy, surgical treatment is recommended. In addition, patients who want to have children and are found to have possible endometrial polyps are also recommended to try for pregnancy after surgery. Hysteroscopic polypectomy is the main treatment method with relatively low associated risks, and all removed tissues are sent for pathological examination.

(1) The surgery is usually performed 3 to 7 days after the end of menstruation. Sexual intercourse is prohibited 3 days before the surgery. You can hold your urine for a while before the surgery to facilitate B-ultrasound monitoring during the surgery.

(2) Rest for at least one week after surgery. Sexual intercourse and bathing are prohibited within one month after surgery.

(3) Pay attention to changes in the condition. There may be a small amount of vaginal bleeding within 2 months after hysteroscopic transurethral resection. If the bleeding is heavy, seek medical attention immediately. Normal menstruation can be resumed in the 3rd month.

3. Radical surgery

For patients over 40 years old, if the bleeding symptoms are obvious, the above treatment cannot eradicate them or they recur frequently, total hysterectomy may be considered.

Prognosis

25% of endometrial polyps (especially those less than 1 cm in diameter) can disappear on their own; hysteroscopic polypectomy can improve the symptoms of abnormal uterine bleeding in 75% to 100% of cases; removing endometrial polyps can improve fertility in infertile patients. This disease is prone to recurrence, and regular follow-up examinations should be conducted after surgery, once every 3 months. However, for those asymptomatic, repeated surgical treatment is not necessary.