妊娠期宫颈息肉摘除术后妊娠结局分析

Analysis of pregnancy outcomes following cervical polypectomy during pregnancy

目的探讨妊娠期子宫颈息肉摘除患者的妊娠结局。方法选择2002年1月至2016年10月在北医三院定期产检妊娠合并宫颈息肉的孕妇92例,其中初产妇81例(88.0%),经产妇11例(12.0%)。对孕妇年龄、症状、初诊孕周、孕期合并症、手术时液基波层细胞学检查(TCT)检查、宫颈分泌物培养结果、术后病理等临床资料进行回顾性分析,所有病例行病理检查以明确诊断。结果妊娠合并宫颈息肉最常见症状为阴道出血,约占82.6%,多因考虑先兆流产行妇科检查时发现。孕期无症状者而分娩时发现者约占15.2%。部分患者可表现为白带异常和阴道肿物脱出,两者各占1.1%。孕期行宫颈息肉摘除术者共85例,其中8例发生流产,占9.4%。77例均至孕足月分娩,约占90.6%。对足月分娩患者术后病理分析,宫颈息肉占88.3%。而发生流产的8例患者,5例为体外受精-胚胎移植,术后病理多提示与感染有关。未行宫颈息肉摘除术者共7例,其中6例均足月分娩,1例孕23周发生难免流产,病理提示重度绒毛膜炎。结论妊娠合并宫颈息肉患者可根据自身条件综合评估,无合并症者行息肉摘除,妊娠结局与受孕方式及病理类型、是否合并感染有关。

Objective To describe the pregnancy outcomes of patients who underwent cervical polypectomy during pregnancy.Methods We included a total of 92 pregnant women who had received regular prenatal health examinations in the hospital during January 2002 and October 2016 and were diagnosed as having cervical polyp through pathology,including 81(88.0%)primipara and 11(12.0%)multiparous women.Data on maternal and clinical characteristics were extracted from the medical records,including maternal age at pregnancy,major symptoms,gestational age of diagnosis,and gestational complications,as well as information on Thinprep cytologic test(TCT),cervical secretions,and pathology.Results The most common symptoms of cervical polyps during pregnancy was vaginal bleeding,accounting for 82.6%of the patients,and most of these patients were identified when they received gynecological examinations due to threatened abortion.Of these 92 patients,14(15.2%)were asymptomatic and diagnosed during delivery.Abnormal vaginal discharge and vaginal masses each occurred in 1.1%of the patients.Of these 92 patients,85 underwent cervical polypectomy during pregnancy,of which 8(9.4%)had miscarriage and 77(90.6%)delivered at full term.The postoperative pathological analysis indicated that cervical polyp accounted for 88.3%of patients who delivered at term.Of the eight patients with miscarriage,five underwent in vitro fertilization-embryo transplantation(IVF-ET);postoperative pathology indicated that the miscarriages were possibly related to infection.Of the 7 patients who did not receive cervical polypectomy,6 delivered at full term and 1 had an inevitable abortion in 23 weeks of gestation due to severe chorioamnionitis.Conclusion Whether cervical polyp patients need to be treated by cervical polypectomy during pregnancy should be determined the patients’conditions.Removal of polyps for patients without complications is possibly not associated with adverse pregnancy outcomes.The pregnancy outcomes of the patients are likely related to the way of conception,pathological patterns and infection.