Perinatal Outcomes in Women With Endocervical and Decidual Polyps During Pregnancy

Article information

J Korean Soc Matern Child Health. 2023;27(3):135-136
Publication date (electronic) : 2023 July 31
doi :
1Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Dongguk University Ilsan Hospital, Goyang, Korea
2Department of Obstetrics and Gynecology, Keimyung University School of Medicine, Dongsan Medical Center, Daegu, Korea
Corresponding Author: Jin-Gon Bae Department of Obstetrics and Gynecology, Keimyung University School of Medicine, Dongsan Medical Center, 65 Bonghwang-ro, Gyeongju 38144, Korea Tel: +82-53-258-7806, Fax: +82-53-258-4848 Email:
Received 2023 April 3; Revised 2023 April 26; Accepted 2023 April 26.

Polyps observed in the cervix during pregnancy are benign gynecological neoplasms found in 2%-5% of women of child-bearing age (Farrar & Nedoss, 1961; Younis et al., 2010). Cervical polyps can be asymptomatic during pregnancy but often cause repetitive vaginal bleeding. Moreover, they can cause preterm labor, infection, chorioamnionitis, and increased bleeding during labor (Golan et al., 1994; Wakimoto et al., 2022).


Two main types of polyps are observed in the cervix during pregnancy: endocervical and decidual polyps (Riemma et al., 2023). Of these, endocervical polyps are the most common, and appear as proliferative lesions in the endocervical mucosa (Bornstein et al., 2012). In contrast, decidual polyps arise from the uterine decidua and show focal stromal pseudodecidualization, making them difficult to distinguish during pregnancy (Seo et al., 2020).


Although cervical polyps are benign, they may cause atypical symptoms such as vaginal bleeding, increased vaginal discharge, and localized infection. A recent study found that the detection of polyps in early pregnancy is a risk factor for preterm delivery before 28 weeks and at 34 and 37 weeks of gestation. Furthermore, cervical polyps are also are highly associated with cervical insufficiency (Hirayama et al., 2022). Another study found that the risk of preterm delivery before 37 weeks of gestation and spontaneous abortion are higher in pregnant women with decidual polyps than in those with endocervical ones (Tokunaka et al., 2015).

A 2021 retrospective cohort study of 4,172 pregnant women included 92 patients diagnosed with cervical polyps before 12 weeks of gestation who had not undergone polypectomy. This study reported that the incidence of spontaneous preterm birth before 34 weeks of gestation was higher in pregnant women with cervical polyps than in those without them (5.4% vs. 0.7%, p<0.01). Furthermore, regression analysis revealed that cervical polyps are an independent risk factor for spontaneous preterm birth before 34 weeks of gestation, with an odds ratio of 4.09 (Wakimoto et al., 2022). Despite these findings, continued research on cervical polyps is required because studies on the effects of cervical polyps during pregnancy are limited, and their management remains controversial.


Previous studies have suggested that the management of these polyps during pregnancy includes polypectomy and cer vical cerclage with or without polypectomy. A 2014 study that investigated pregnant women who underwent polypectomy for decidual polyps in the first and second trimesters found that the risks of abortion and preterm delivery were highly associated with polypectomy. Thus, surveillance of polyps during pregnancy is recommended unless malignancy is suspected (Tokunaka et al., 2015).

A meta-analysis of the surgical management of endocervical and decidual polyps during pregnancy (Riemma et al., 2023) revealed that there were no significant differences in late pregnancy losses in women who underwent endocervical or decidual polypectomy in their first trimester. However, the risk of preterm birth was significantly higher in women who underwent decidual polypectomy than in those who underwent endocervical polypectomy (relative risk, 6.13).

Polypectomy methods have been reviewed in a case report. A patient with intermittent spotting for 2 weeks was diagnosed with a 3-cm friable endocervical polyp on speculum examination. She underwent polypectomy for its removal. On the ultrasound scan at 20 1/7 weeks, a suture was noted in the cervical canal; however, it was not found in the third trimester. The author highlighted that infection may occur due to suture site migration, which is caused by the enlargement of the uterus after the second trimester and placental migration (Kondagari & Josephs, 2021). Another study recommended cervical cerclage for pregnant women with cervical polyps (Hirayama et al., 2022). A preliminary report published in 2022 did not recommend polypectomy for decidual polyps; it recommended cervical cerclage in the event of cervical shortening remote from term (Misugi et al., 2022).

Polyps are relatively common during pregnancy; however, their management is controversial. Further multicenter studies on cervical polyps and their management are warranted, considering the profoundly negative perinatal outcomes associated with endocervical and decidual polyps.


The authors have nothing to disclose.


Bornstein J, Bentley J, Bösze P, Girardi F, Haefner H, Menton M, et al. 2011 Colposcopic terminology of the international federation for cervical pathology and colposcopy. Obstet Gynecol 2012;120:166–72.
Farrar HK Jr, Nedoss BR. Benign tumors of the uterine cervix. Am J Obstet Gynecol 1961;81:124–37.
Golan A, Ber A, Wolman I, David MP. Cervical polyp: evaluation of current treatment. Gynecol Obstet Investig 1994;37:56–8.
Hirayama E, Ebina Y, Kato K, Akabane-Nakagawa K, Okuyama K. Cervical polyps in early pregnancy are a risk factor for late abortion and spontaneous preterm birth: a retrospective cohort study. Int J Gynaecol Obstet 2022;156:64–70.
Kondagari L, Josephs LS. Role of ultrasound in managing cervical polyps during pregnancy. Cureus 2021;13:e18702.
Misugi T, Kitada K, Fudaba M, Tanaka S, Kurihara Y, Tahara M, et al. Preliminary outcomes of cervical cerclage for shortened cervix with decidual polyp. Healthcare (Basel) 2022;10:1312.
Riemma G, Della Corte L, Vitale SG, Cianci S, La Verde M, Giampaolino P, et al. Surgical management of endocervical and decidual polyps during pregnancy: systematic review and meta-analysis. Arch Gynecol Obstet 2023;307:673–80.
Seo N, Tachibana D, Misugi T, Koyama M, Tanaka S. First trimester findings of decidual polyp: caution to avoid polypectomy. Eur J Obstet Gynecol Reprod Biol 2020;249:109–10.
Tokunaka M, Hasegawa J, Oba T, Nakamura M, Matsuoka R, Ichizuka K, et al. Decidual polyps are associated with preterm delivery in cases of attempted uterine cervical polypectomy during the first and second trimester. J Matern Fetal Neonatal Med 2015;28:1061–3.
Wakimoto T, Hayashi S, Koh I, Yamamoto R, Ishii K. Relationship between unremoved cervical polyp in pregnancy and spontaneous preterm birth. Am J Obstet Gynecol 2022;227:899.e1–899.e6.
Younis MT, Iram S, Anwar B, Ewies AA. Women with asymptomatic cervical polyps may not need to see a gynaecologist or have them removed: an observational retrospective study of 1126 cases. Eur J Obstet Gynecol Reprod Biol 2010;150:190–4.

Article information Continued