Placental polyp is a polypous formation formed in the uterine cavity from the remnants of placental tissue after complicated childbirth, artificial termination of pregnancy or miscarriage. Pathological manifestations caused by placental polyp include late postpartum or post-abortion bleeding, sometimes quite intense, leading to the development of anemia and the addition of a secondary infection. Disease is diagnosed by collecting an obstetric and gynecological anamnesis, conducting a bimanual examination, ultrasound, hysteroscopy and RDV with histological analysis of scraping. Treatment is surgical (removal of the root canal, laser, hysteroresectoscopy, etc.).
Placental polyp is a pathological overgrowth formed from the remaining parts of the placenta in the uterine cavity. It can have a wide base or a thin leg. According to foreign authors, disease occur in about 0.36% of births. Pathology should be distinguished from decidual uterine polyp – benign growth of the endocervix mucosa with its hormonal transformation (decidualization) during pregnancy, which does not require special treatment and does not threaten the health of the woman and fetus. Meanwhile, placental polyp is regarded in gynecology as a pathological formation, since it does not disappear on its own, is accompanied by severe bleeding, predisposes to the development of serious complications: anemia, endometritis, sepsis, infertility.
The formation is preceded by a completed or aborted pregnancy. At the same time, the outcome of pregnancy can be different: childbirth (natural or cesarean section), spontaneous termination (miscarriage), medical abortion, frozen pregnancy followed by instrumental removal of the fetal egg. However, in all cases, the onset of polyp development is given by placental lobules or placental villi trapped in fibrinoid layers or thrombotic masses lingering in the uterine cavity. The delay of placental tissue in the uterine cavity is facilitated by irrational management of the postpartum period, incomplete separation and removal of the afterbirth during cesarean section, incomplete curettage of the uterine cavity during medical abortion or miscarriage.
The fragment of placental tissue remaining in the uterine cavity and tightly attached to its wall is covered with blood clots and fibrin for a short time, sprouts connective tissue. Externally, the placental polyp looks like a flat (creeping) or a mushroom-like growth. Pathomorphologically, it is customary to distinguish placental polyps consisting of preserved villi (formed after medical abortion), destructive villi (occur against the background of incomplete postpartum involution of the uterus), as well as isolated placental lobules having vascular connections with the uterus.
The final organization occurs a few weeks after the end of pregnancy. That is why the clinical manifestation of the disease occurs in the third to fifth week after childbirth, abortion, miscarriage. The leading symptom is bleeding, which is often perceived by a woman as a natural phenomenon after the events. However, unlike physiological postpartum bleeding, spotting caused appears quite late, and unlike post–abortion, it persists for a longer time. At first, the blood discharge may be quite scarce, but over time, the bleeding increases so much that it forces the patient to consult a gynecologist.
If this disease caused heavy or prolonged uterine bleeding, weakness, dizziness, fatigue, pallor of the skin develops. The consequence of blood loss can be severe anemia, the addition of secondary infection with the development of endometritis, sepsis. In the long term, untimely treatment of placental polyp can lead to infertility.
Diagnosis and treatment
A presumptive diagnosis can be made in cases when a woman notes an increase or resumption of blood secretions 3-4 weeks after childbirth or medical abortion. When examined on the chair, the gaping of the uterine pharynx can be determined, sometimes the polyp pole protruding from the outer opening of the cervical canal. More reliable data on the presence of additional education in the uterine cavity, its localization and structure allows us to obtain ultrasound of the pelvic organs.
The most informative study for suspected placental polyp is hysteroscopy, which makes it possible to examine the uterine cavity from the inside using an optical system. Diagnostic capabilities of hysteroscopy are usually combined with surgical intervention – hysteroresectoscopy and separate diagnostic curettage. Subsequent histological examination of endometrial scraping finally confirms the diagnosis of placental polyp.
If the lower part of the polyp is visualized in the cervical canal, an obstetrician-gynecologist can remove it with a cornet. It is possible to remove the placental polyp using a surgical laser. In all cases, the removal procedure is supplemented with fractional curettage. In order to correct anemia, the patient is prescribed multivitamins, iron preparations, according to indications, blood components (plasma, erythrocyte mass) are transfused.
In the postoperative period, monitoring of body temperature and general well-being is necessary. During the month, it is recommended to exclude thermal procedures (including baths) and physical activity, beware of hypothermia, refrain from sexual activity. Prevention of the formation consists in a thorough examination of the placenta after childbirth by a midwife, if necessary, conducting a manual examination of the uterine surface of the woman in labor, monitoring the nature of discharge after childbirth and termination of pregnancy, conducting control examinations by a gynecologist and ultrasound control.