Severe bleeding from a pregnancy tumor. A case report

Hyperplastic gingivitis and gingival hyperplasia accompanying gestation have been termed "pregnancy gingivitis" and "pregnancy tumor." The condition is benign but, rarely, is complicated by severe bleeding that is difficult to manage. A single case of a pregnancy tumor is reported.

A 28-year-old woman in the third trimester was evaluated for treatment of a pregnancy granuloma with recurrent episodes of severe bleeding for two weeks. Conservative management by firm pressure on gauze packs was applied to control the bleeding, but in vain. Induction of labor was conducted at 37 weeks partially because of term pregnancy and uncontrollable bleeding from the gingiva. An emergency cesarean section was done because of acute fetal distress during induction of labor. A healthy infant was delivered. The gingival bleeding stopped spontaneously five days afterwards. The patient was given thorough dental prophylaxis and oral hygiene instructions. The buccal granulomatous tumor was decreased in size four weeks postpartum.

Careful oral dental hygiene, removal of dental plaque and debris, and use of soft toothbrushes are important during pregnancy to avoid occurrence of a pregnancy tumor. If uncontrolled bleeding occurs, management should be based on the individual condition and should range from supportive therapy--such as desiccation of bleeders; local, firm compression and oral hygiene to blood transfusion--as well as medication to accelerate fetal lung maturity or even termination of pregnancy to save the patient's life, as with treatment of uncontrollable eclampsia.