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Introduction
ndocervical polyps, though common 1Ein routine gynaecologic practice,
rarely complicate pregnancy. Very few
such cases have been described in the 2,3literature. During pregnancy, they may
present with various complications like 3inevitable abortion in early pregnancy or
later on as extraplacental causes of 4bleeding. Very rarely, they may present
5for the first time in intrapartum period,
where they can cause management
dilemma. The standard literature is mostly
noncontributory in such cases, possibly
due to the rarity of such a condition. We
present one such rare presentation of a
large endocervical polyp diagnosed for the
first time in the intrapartum period.
Case Report A 23 year old primigravida was admitted at 40
weeks 5 days of gestation with no contributory
medical or surgical history. Her haemoglobin was
10 gm% and antenatal sonography was normal.
Initially, induction with dinoprostone gel was done.
However, in view of non-reassuring foetal heart rate
pattern, a lower segment caesarean section was done
and a 2.6 kg female was delivered as vertex. The apgar
score at 1 and 5 min was 9/10. The placenta
separated spontaneously after baby delivery and was
extracted completely. After placental delivery, a large
bilobed polyp-with one lobe 3 x 3 cms and the other 4
x 3 cm with a common broad pedicle. (as shown in
figure) was seen arising from anterior endocervical
canal. In view of the broad pedicle and large size,
polyp was not removed during surgery. The uterus
and abdomen was closed in layers. Postpartum
period was uneventful. The patient was advised to
report immediately in case of a bleeding, fever or foul
smelling discharge. On follow up at six weeks post-
partum, per speculum examination was normal and
sonography showed marked reduction in the size of
the polyp which was now 3 x 3 mm in size. The polyp
was removed and histopathology showed no
neoplastic changes.
Fig. showing Bilobed Polyp Intraoperatively
Discussion
Cervical polyps can grow significantly 5in pregnancy and intrapartum period.
The possible explanation for such a size
*Lecturer, **Senior Registrar, ***Professor and Unit Head, Dept. of Obstetrics and Gynaecology, K.E.M. Hospital and Seth G. S. Medical College, Mumbai -400012.
Abstract
Endocervical polyps complicating pregnancy are very rare. They can have variable
clinical presentation ranging from abortion in early pregnancy to extraplacental
vaginal bleed. Very rarely, it can present in the intrapartum period. The literature on
intra partum endocervical polyps is very limited and mostly non conclusive, perhaps
due to the rarity of the condition, thus causing potential management dilemma when
faced with such a situation. Here we present one such rare presentation of a large
bilobed endocervical polyp diagnosed for the first time in the intrapartum period.
A Large Intrapartum Endocervical Polyp
Sachin Pardeshi*, Shiba Mittal**, Niranjan M Mayadeo***, Shilpa Chakre*
2 Lobes
of the
Polyp
Single
Thick
pedicle
Bombay Hospital Journal, Vol. 57, No. 3, 2015 353
change could be the increased vascularity
& also possibly hormonal changes, since
change has also been reported in patients 6taking oral contraceptives. This also
explains the marked reduction in size on
follow up. There are no management
guidelines available, but intervening in the
intrapartum period when the size is large
can lead to possible complications like
bleeding & perhaps increased morbidity .
References1. Salim S, Won H, Nesbitt-Hawes E et at.
Diagnosis and management of endometrial
polyps: a critical review of the literature. J Minim
Invasive Gynecol. 2011 Sep-Oct;18(5):
569-81.
2. Martincik J. Endocervical polyp as a cause of
hemorrhage in the 2nd half of pregnancy. Cesk
Gynekol. 1973 Jun;38(3):341.
3. Adinma JI. Cervical polyp presenting as
inevitable abortion. Trop O oct 1989; 19: 181
4. Gabrielsen G. Pregnancy revealed by the
anatomopathologic examination of an
endocervical polyp. Bull Fed Soc Gynecol Obstet
Lang Fr. 1965 Sep-Oct;17(4):345-6.
5. Tang H, Jones I. An intrapartum giant cervical
polyp. N Z Med J 2004; 117:U1181.
6. Duparc J, Boyron P. Polypous endocervical
polyadenoma in a woman taking an oral
contraceptive. Bull Fed Soc Gynecol Obstet Lang
Fr. 1971 Jan-Mar;23(1 ):41-2.
Bombay Hospital Journal, Vol. 57, No. 3, 2015354
Diagnostic accuracy of single baseline measurement of Elecsys Troponin T
high-sensitive assay for diagnosis of acute myocardial infarction in emergency
department: meta-analysis
What is the diagnostic accuracy of a single baseline measurement of the Elecsys Troponin T high-sensitive assay (Roche Diagnostics) for the diagnosis of non-ST segment elevation acute myocardial infarction in patients presenting to the emergency department with symptoms suggestive of acute coronary syndrome?
Summary Answer
If 14 ng/L is used as a positivity threshold the sensitivity would be 89.5% (95% confidence interval 86.3% to 92.1%) and the specificity 77.1% (68.7% to 83.7%), whereas using 3 ng/L or 5 ng/L would result in a sensitivity of 97.4% (94.9% to 98.7%) and a specificity of 42.4% (31.2% to 54.5%)
Zhivko Zhelev, Christopher Hyde, Emily Youngman, et al, BMJ, 2015, Vol 350, 13
Therapeutic advances for treatment-resistant cough
Although most cases of cough are secondary to acute viral upper respiratory tract infections and are usually self-limiting, in a cross-sectional survey, 7% of individuals reported chronic cough (defined as a cough lasting longer than 8 weeks) that was severe enough to interfere with normal daily activity.
Abdulqawi and colleagues showed that treatment with AF-219 was associated with a significant improvement in both objective cough counts and patient-reported outcomes including rating of cough severity, urge to cough, cough-specific quality of life, and global ratings of change in patients with idiopathic chronic cough. In conclusion, AF-219 is a first-in-class P2X3 receptor antagonist that has shown unprecedented efficacy in patients with chronic idiopathic cough.
Maria G Belvisi, The Lancet, 2015, Vol 385, 1160-1161