Cervical and Vaginal Deciduosis: Insights on Management and a Systematic Review of Observational Studies on Pregnancy Complications and Management Outcomes (Including Vaginal Birth)

Zoryana Bolgarina, Heet N Desai, Mithum Senaratne, Shivling S Swami, Soe Lwin Aye, Yash Vardhan Trivedi, Abeer O Elshaikh
In: Cureus · 2023 · vol. 15(8) , pp. e44479 · doi:10.7759/cureus.44479 · PMID:37791171 · PMC10544384 · W4386318690
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⚙ AI-generated summary by claude@2026-06, 2026-06-08 ⓘ

This systematic review of 15 observational studies on cervical and vaginal deciduosis found recurrent vaginal bleeding, significant antenatal hemorrhages, and preterm birth to be common, with lesion resection effectively resolving symptoms.

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⚙ AI-generated deep summary by claude@2026-06, 2026-06-08 ⓘ

This paper presents a systematic review of worldwide English-language observational studies (plus reference-list searching) on pregnancies complicated by cervical and vaginal deciduosis, extracting patient features, diagnostic challenges, management details (e.g., biopsy, polypectomy, observation), pregnancy complications, and symptom/lesion outcomes across 30 pregnancies from 15 studies. Across these reports, macroscopic cervical/vaginal deciduosis more often presented with recurrent vaginal bleeding (57% of 24 women), and clinicians faced frequent differential diagnoses including miscarriage, cervical pregnancy, placenta previa, and malignancy. Significant antenatal hemorrhage, preterm rupture of membranes, and preterm birth were the most frequent pregnancy complications, while intervention-associated uncontrolled bleeding was rare (0.04% after electively performed procedures), and symptom cessation after lesion resection was reported in 100% of eight patients versus 53% under observation; however, the review is limited by its reliance on observational case-based evidence and small numbers per outcome. The paper relates to endometriosis because it cites prior systematic reviews noting “endometriotic lesion decidualization” as a deciduosis-associated phenomenon, linking decidualization of endometriosis-related lesions with pregnancy complications in the broader deciduosis literature.

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Abstract

INTRODUCTION: Deciduosis is an ectopic transformation of connective tissue into decidual-like cells. This is the first systematic review describing the clinical course, associated pregnancy complications, and management outcomes of cervical and vaginal deciduosis. METHODS: Our search covered worldwide observational studies published in English in five databases (PubMed, PubMed Central (PMC), Europe PMC, ScienceDirect, and Google Scholar) from inception to February 24, 2023. We followed the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines and critically appraised studies using CAse REport (CARE) and Joanna Briggs Institute (JBI) tools. Then, we extracted patient characteristics, clinical features, management-related information, and outcomes. RESULTS: The selection process identified 15 studies describing 30 pregnancies. Macroscopic cervical and vaginal deciduosis presented as recurrent vaginal bleeding in over 16 of 24 women (57%). Differential diagnoses included miscarriages, cervical pregnancy, placenta previa, and malignancy. Significant antenatal hemorrhages, preterm rupture of membranes, and preterm birth were the most frequent pregnancy complications. Only one of 27 electively performed procedures resulted in biopsy-induced uncontrolled vaginal bleeding (0.04%), suggesting the relative safety of the interventions. Lesion resection led to the cessation of recurrent symptoms in eight of eight patients (100%) compared to eight of 15 women (53%) under observation management. All women with polypoid deciduosis over 1.5 cm entered labor and delivered without complications. CONCLUSIONS: We described the clinical course, pregnancy complications, diagnostic-related challenges, management, and associated outcomes in women with macroscopic cervical and vaginal deciduosis. We supported the analysis with the current state of the problem and discovered gaps for prospective studies.

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