Management of pregnant women with endocervical and decidual polyps: a systematic review and meta-analysis

The impact of polypectomy of endocervical and decidual polyps during pregnancy on the risk of spontaneous late miscarriage and preterm delivery has not been determined. The existing systematic reviews included only three studies that could not yield definite conclusions.

The PubMed, EMBASE, Cochrane Library, Wanfang Med and CNKI databases were searched from inception until July 1, 2024. Studies of women who were diagnosed with endocervical and decidual polyps during pregnancy and who received treatment or observation were included. Studies without a control group were excluded. Randomized controlled trials and case‒control, cohort, and cross-sectional studies were included in this review. Two reviewers independently screened the studies for inclusion and extracted the data. Methodological quality was evaluated with the Newcastle‒Ottawa Scale. Statistical analysis was performed via Review Manager software version 5.4, employing fixed-effects or random-effects meta-analyses as appropriate, to estimate odds ratios with 95% confidence intervals.

Of the 1696 initially identified articles, 12 met the inclusion criteria and were included in the review. These 12 studies, comprising data from 8337 women, underwent quantitative analysis. The results of the meta-analyses revealed a significantly greater risk of miscarriage (OR, 11.19; CI 4.63-27.04) and preterm delivery (OR, 9.41; CI 3.40-26.04) in women with endocervical polyps than in those without. Endocervical polypectomy had no significant influence on subsequent miscarriage (OR, 1.28; CI 0.69-2.36) or preterm delivery (OR, 1.12; CI 0.36-3.49). Conversely, the removal of decidual polyps was associated with a significantly greater risk of miscarriage (OR, 2.77; CI 1.45-5.27) and preterm birth (OR, 3.42; CI 1.09-10.72) than endocervical polypectomy was. Furthermore, polypectomy performed before the 12th gestational week was associated with an increased risk of miscarriage (OR, 2.87; CI 1.08-7.59), although not preterm delivery (OR, 1.18; CI 0.61-2.30).

In pregnant women, polypectomy for endocervical or decidual polyps does not have a significant negative effect on miscarriage or preterm delivery, and it is better to perform the operation after the 12th gestational week. However, the presence of decidual polyps may pose a heightened risk for adverse obstetric outcomes.