A Rare Case of Symptomatic Recurring Decidual Polyp in Each Pregnancy in a Woman with Primary Infertility

Abstract

Introduction: Decidual polyps are protruding nodules of ectopic deciduosis of endocervical
stroma that occur during pregnancy. They are benign changes, associated with recurrent
vaginal bleeding and infections, which can result in miscarriage, preterm premature rupture
of membranes (PPROM), premature labor and/or delivery. There are no strict guidelines for
treating decidual polyps.

Case presentation: 27-year-old first gravida, treated for infertility was admitted at 6 weeks of
gestation with history of vaginal bleeding. Colposcopic examination and vaginal ultrasound
showed 22x10mm decidual polyp, which was removed with a forceps. In the 10th week of
pregnancy she had a missed abortion. In her second pregnancy she experienced the same
diagnosis of decidual polyp 40x10mm, which was not removed but regularly monitored. She
had recurring infections of the urinary tract. Oral antibiotic was administered every time,
but at 22 weeks of gestation she presented with PPROM and had an induced abortion. Fetal
autopsy showed inflammation of the placenta due to infection. Seven weeks into her third
pregnancy, she yet again had vaginal bleeding as a result of yet another decidual polyp
20x18mm. Polypectomy was performed; Urethral swabs were positive for pathogen bacteria
and doxycycline was administered. She delivered a healthy baby at 38th week of pregnancy.

Conclusion: This showed a rare case of recurring symptomatic decidual polyp in each
pregnancy, which led to loss of fetus in the first two. In lack of clear guidelines, we claim
that frequent check-ups, urethral swabs and polypectomy in first trimester should result in a
delivery of a healthy baby.