Cervical Polyps During Pregnancy
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|How Are Cervical Polyps Treated In Pregnancy?
The diagnosis of cervical polyps in pregnant women is not uncommon (particularly in women who have already had one child). The spike in estrogen hormones caused by pregnancy is probably a contributory factor. Most times a polyp does not cause symptoms (it is asymptomatic) and the woman does not know it exists. It may be noticed during a routine examination or at the time of childbirth. Other times the polyp is symptomatic with various signs including vaginal bleeding after intercourse or a foul smelling discharge if the polyp is infected or if there is a recurrent vaginal infection (see, symptoms of cervical polyps). The management of polyps during pregnancy is usually conservative, particularly in the first trimester when the risk of miscarriage is highest.
If a polyp remains small and is asymptomatic the doctor will usually recommend waiting until after childbirth to have it removed. Most polyps are small and less than 2cm long. However, there are limited studies which show that polyps in pregnancy can modify the enzyme properties of the cervix raising the risk of inflammation, local infection and even chorioamnionitis (inflammation of the fetal membranes). For this reason, some gynecologists insist on removing all polyps in pregnant patients, regardless of size. If polypectomy (the standard treatment of cervical polyps) cannot be performed, local anti-inflammatory and antimicrobial therapy may be used. As research into the management of small polyps in pregnancy is so limited, there are no accepted treatment protocols. It depends on the practice of the doctor consulted.
If a polyp grows considerably and becomes symptomatic or starts to protrude through the vulva giving pain, removal is nearly always recommended. Larger growths increase the risk of recurrent bleeding and infections. If a growth protrudes (which is relatively rare) it could lead to premature labor, delivery difficulties or an increased risk of bleeding during labor. A polypectomy is normally the recommended course of treatment. Where possible, the doctor will choose to wait until at least the middle of the second trimester when pregnancy is well established. In the meantime you may be advised to abstain from intercourse to avoid irritating the growth.
Polypectomy: A looped forceps is used to grasp the base of the polyp and the lesion is removed with a twisting motion. Depending the shape of the polyp (some have stalks while others are flatter and broader), twisting is not always appropriate. Pregnancy increases blood flow in the cervix and there is a risk of significant bleeding with some types of lesions. Other treatment options include:
A woman, aged 27 and 19 weeks pregnant presented at her gynecologist with a blood stained discharge. She had normal pap smear test results in the past and her 19 week ultrasound scan looked normal and showed no placental cause for bleeding. At week 21 a large polyp (measuring 5x3cm) was diagnosed during a vaginal examination. One week later it measured 5x7cm and was becoming inflamed and elongated. She was given cephalexin to treat symptoms of cystitis, which improved within a day or two. However one week later she was readmitted complaining of vaginal discomfort and heavier bleeding. At this point the polyp was visibly protruding through the vulva. She was given steroids and a smear test taken from the polyp to rule out cancer. Finally at week 29, the polyp was removed under spinal anesthesia. She was discharged the next day and all recurrent bleeding and discomfort disappeared. She had a normal vaginal birth 10 days later. The biopsy showed no malignancy, it was a benign endocervical polyp. A follow up took place three months later and all looked normal.
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