Clinical application of hysteroscopic decidual polypectomy in pregnant women

Clinical application of hysteroscopic decidual polypectomy in pregnant women | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Clinical application of hysteroscopic decidual polypectomy in pregnant women Yi Yu, Dongdong Shi, Long Sui, Hongwei Zhang, Limei Chen This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7627647/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 08 Jan, 2026 Read the published version in BMC Pregnancy and Childbirth → Version 1 posted 12 You are reading this latest preprint version Abstract Objective: This study aims to explore the clinical efficacy and safety of hysteroscopic decidua polypectomy during pregnancy. Methods: This retrospective study analyzed 38 patients presenting with recurrent vaginal bleeding due to pregnancy-associated decidual polyps who underwent hysteroscopic polypectomy at the Obstetrics and Gynecology Hospital of Fudan University from January 2023 to January 2025. Data on surgical techniques, timing of intervention, and subsequent pregnancy outcomes were evaluated. Results: A total of 38 patients who underwent hysteroscopic decidual polypectomy were included in this study, with an age range of 23-39 years (mean 28.7 ± 2.4 years). Among them, 31 were primiparous and 7 were multiparous. The gestational age at surgery ranged from 8 to 19 weeks (mean 11.0 ± 3.2 weeks). All 38 patients presented with recurrent vaginal bleeding during pregnancy. The polyp diameter ranged from 1.4 to 5.5 cm (mean 3.82 ± 1.50 cm), with 22 cases (57.9%) having a diameter greater than 3 cm. All 38 patients successfully underwent hysteroscopic resection. The operative time ranged from 4 to 10 minutes (mean 5.43 ± 1.42 minutes), , with intraoperative blood loss of 0–5 ml (mean 2.53 ± 0.49 ml). No patient experienced postoperative rebleeding or any perioperative complications. Of the 38 patients, 37completed pregnancy; the full-term delivery rate was 94.6% (35/38), with gestational age at delivery of 37–41.4 weeks (mean 39.12 ± 1.02 weeks). Among these, 26 spontaneous vaginal deliveries, 8 cesarean sections, and 1 forceps delivery. The preterm birth rate was 5.3% (2/38), and the spontaneous abortion rate was 2.6% (1/38). Conclusion: Hysteroscopy allows for painless, rapid, and precise resection of decidual polyps with effective hemostasis. It represents a safe and effective surgical approach for treating decidual polyps during pregnancy, but should be performed by experienced hysteroscopists to ensure optimal outcomes. Hysteroscopy Pregnancy Decidual polyp Pregnancy outcomes Figures Figure 1 Figure 2 Introduction Decidual polyps, also referred to as decidual prolapse, are characterized by the hyperplasia and edema of uterine decidua, which prolapses through the external cervical canal[ 1 , 2 ]. Typical decidual polyps are observed exclusively in pregnant women, while a few atypical cases of decidual reaction polyps have been reported in non-pregnant individuals receiving long-term progestin therapy[ 3 , 4 ]. The prevalence is low, and literature is scarce, limited to case reports and small case series. In recent years, there has been a notable increase in the number of patients diagnosed with pregnancy complicated by decidual polyps, likely related to more patients undergoing in vitro fertilization and embryo transfer (IVF-ET) or receiving progestin therapy for threatened miscarriage, attracting clinical attention[ 5 – 7 ]. Decidual polyps extend throughout the cervical canal, disrupting the natural cervical barrier, and are highly susceptible to bleeding and necrosis, markedly increasing the risks of intrauterine infection, miscarriage, and preterm birth[ 8 ]. Currently, there is no unified recommendation for the management of decidual polyps during pregnancy. Indications for surgery should be carefully assessed, considering patient psychological status, bleeding duration, and impact on pregnancy outcomes[ 9 , 10 ]. This study retrospectively analyzed the clinical data of 38 patients with recurrent vaginal bleeding due to decidual polyps during pregnancy who underwent hysteroscopic resection after poor response to conservative medical treatment. The surgical methods, timing of intervention, and subsequent pregnancy outcomes were evaluated to investigate the clinical efficacy and safety of hysteroscopic polypectomy in pregnant women. Materials and Methods Patients and procedure This study was a retrospective investigation conducted at the Hysteroscopic Center, Obstetrics and Gynecology Hospital of Fudan University. The study was approved by the Ethics Committee of the Obstetrics and Gynecology Hospital of Fudan University (approval number: 2023-12) and we confirm that the methods used in the study comply with the relevant guidelines and regulations. The study cohort comprised 38 patients who underwent hysteroscopic resection of decidual polyps during pregnancy at our hospital between January 2023 and January 2025. All participants had undergone cervical cytology screening (ThinPrep Cytologic Test, TCT) and human papillomavirus (HPV) testing either prior to pregnancy or during early gestation to exclude cervical lesions. Inclusion criteria (1) Age 18–40 years; (2) Intrauterine viable pregnancy confirmed by ultrasound with recurrent vaginal bleeding during pregnancy; (3) Presence of polypoid cervical lesions confirmed by gynecologic examination. Exclusion criteria Use of medications during pregnancy that may affect pregnancy outcomes, severe hepatic or renal dysfunction, cardiopulmonary insufficiency, or significant psychiatric or behavioral disorders. All enrolled patients underwent systematic evaluation in the Cervical Disease Clinic and Obstetrics Clinic prior to admission. They were thoroughly informed about potential risks associated with the procedure, including secondary hemorrhage, infection, and possible induction of abortion. All patients acknowledged understanding the treatment details and provided written informed consent. Prior to the procedure, cervical secretion cultures were performed. Surgery was conducted if the culture result was negative; if positive, sensitive antibiotic treatment was administered first, followed by the operation. Hysteroscopy Prior to the procedure, the location of hypervascular areas within the polyp must be identified by an experienced ultrasonographer. The patient was placed in the lithotomy position, and after general anesthesia, the vulva and vagina were disinfected and draped. Cervical dilation with a speculum was not required. A 7-mm bipolar resectoscope was used, with 0.9% sodium chloride injection as the distension medium. Intrauterine pressure was maintained below 80 mmHg (1 mmHg = 0.133 kPa) to minimize the inflow of saline into the uterine cavity and reduce the risk of infection. Under direct hysteroscopic visualization, the resectoscope was inserted into the cervical canal (Fig. 1 A). The pedicle of the polyp was resected using a bipolar loop approximately 1 cm below the level of the internal cervical canal (Fig. 1 B). In cases of bleeding during resection, the bipolar loop was used for coagulation to achieve hemostasis. The hysteroscope was withdrawn after complete transection of the pedicle (Fig. 1 C), and the procedure was concluded once hemostasis was confirmed. The procedure was concluded once hemostasis was confirmed. Both resection and coagulation were performed at a power setting of 30 W, with a flow rate of 300 ml/min. Prophylactic antibiotics were administered for 24 hours postoperatively. All hysteroscopic procedures in this study were performed by senior hysteroscopists with Level IV certification and over 8 years of experience. Evaluation indicators The following parameters were recorded: operative time, intraoperative blood loss, postoperative pathology, perioperative complications, recurrent bleeding during pregnancy, mode of delivery, gestational age at delivery, and outcomes through the puerperium. Patient satisfaction and adverse events were also documented. Statistical analysis Statistical analysis was performed using SPSS 17.0. The Kolmogorov-Smirnov test was used to assess the normality of continuous variables. Normally distributed data were presented as mean ± standard deviation (x ± s), while non-normally distributed data were expressed as median and interquartile range [M (Q1, Q3)]. Continuous variables were compared before and after treatment using the t-test. Categorical variables were summarized as n (%). A p-value < 0.05 was considered statistically significant. Results General parameters A total of 38 patients were enrolled, with a mean age of 28.7 ± 2.4 years (range: 23–39 years). Among them, 31 were primiparous and 7 were multiparous. The gestational age at surgery ranged from 8 to 19 weeks, with a mean of 11.0 ± 3.2 weeks. All patients presented with recurrent vaginal bleeding during pregnancy, and the time from symptom onset to surgery ranged from 6 hours to 7 days. Preoperative ultrasonography revealed a hypoechoic mass located above the internal cervical canal, extending to the external cervical canal in all cases (Fig. 2 A). Gynecological examination confirmed the presence of polypoid tissue at the external cervical canal in all patients (Fig. 2 B). The polyp diameter ranged from 1.4 to 5.5 cm, with a mean diameter of 3.82 ± 1.50 cm; 22 patients had polyps ≥ 3 cm (Table 1 ). Table 1 Baseline characteristics of patients Characteristics Results Age(years)(mean ± SD) 28.7 ± 2.4 Parity [M(Q1,Q3)] 0 (0,1) Polyp size (mean ± SD) 3.82 ± 1.50 Gestational weeks of polypectomy (mean ± SD) 11.0 ± 3.2 Vaginal bleeding pre-operation(n) 48 Hysteroscopy All 38 pregnant patients successfully underwent hysteroscopic removal of decidual polyps. Operation time ranged from 4 to 10 minutes (mean 5.43 ± 1.42 minutes), with intraoperative blood loss of 0–5 ml (mean 0.53 ± 0.49 ml). No complications such as uterine perforation, massive bleeding, fluid overload, or postoperative infection occurred. Postoperative Outcomes and Pregnancy Results Postoperative pathological examination confirmed the diagnosis of decidual polyp in all cases (Fig. 2 C). None of the patients experienced recurrent bleeding after surgery (Table 2 ). Of the 37 patients who completed pregnancy, the full-term delivery rate was 94.6% (35/38), with gestational age at delivery ranging from 37 to 41 weeks (mean 39.12 ± 1.02 weeks); 26 delivered vaginally, 8 by cesarean section, and 1 by forceps-assisted delivery. The spontaneous abortion rate was 2.6% (1/38); this patient experienced inevitable miscarriage at 24 weeks, with pathology showing decidual polyp and placental pathology revealing chorioamnionitis. Preterm birth occurred in 5.3% (2/38); one patient delivered at 36 weeks by cesarean due to preterm premature rupture of membranes (preoperative cervical cultures were negative), and one delivered at 32 weeks, with a history of cervical conization. Patients with decidual polyps ≥ 3 cm had a higher probability of successful full-term pregnancy than those with polyps < 3 cm (21/22 vs. 14/16), though the difference was not statistically significant (P = 0.069). Table 2 The pregnancy and neonatal outcomes of patients Pregnancy outcomes Results Vaginal bleeding post-operation(n) 0 Gestational weeks at delivery (mean ± SD) 39.12 ± 1.02 Full-term birth[n(%)] 35(94.6) Cesarean section 8(21.1) Spontaneous abortion[n(%)] 1(2.6) Preterm birth[n(%)] 2(5.3) Neonatal birth weight (Kg, mean ± SD) 2.98 ± 0.85 Apgar score [M(Q1, Q3)]) 1 minute 10.0(10 ~ 10) 5 minute 10.0(10 ~ 10) 10 minute 10.0(10 ~ 10) Discussion Characteristics of Decidual Polyps During Pregnancy Decidual polyps are most frequently observed in the first and second trimesters of pregnancy and represent a relatively common type of polyp during gestation, aside from cervical polyps. The exact pathogenesis remains unclear; however, several studies suggest that decidual polyps represent a specific morphological change in the endometrial tissue during pregnancy[ 11 , 12 ]. Elevated hormone levels and abundant blood supply during gestation promote hyperplasia of endometrial glands, which can cause existing or newly formed cervical polyps to rapidly enlarge and protrude through the external cervical canal, forming decidual polyps. In recent years, with an increase in patients undergoing assisted reproduction and receiving high doses of estrogen and progesterone, the incidence of pregnancy complicated by decidual polyps has risen. Morphologically, decidual polyps are tongue- or polyp-shaped, fragile, and prone to bleeding. Histologically, glands are diffusely distributed, stromal cells show decidual changes, and inflammation, hemorrhage, necrosis, or thrombosis may be present. Polyps can be solitary or multiple and are difficult to distinguish from cervical polyps macroscopically. Pathological terminology varies, including “cervical polyp with decidual change,” “decidual fragment,” or “endometrial polyp with decidual change”[ 13 – 15 ]. Pregnancy-associated decidual polyps often present as painless vaginal bleeding; therefore, first-trimester vaginal bleeding should not be immediately diagnosed as threatened or inevitable miscarriage, and vaginal examination is required for definitive diagnosis. Compared with cervical polyps, decidual polyps are more fragile and prone to contact bleeding, often with purulent secretions on the surface. Ultrasound may show polyps extending from the uterine cavity downward through the cervical canal[ 16 ]. Definitive diagnosis requires histopathology. Surgical Indications for Decidual Polyps During Pregnancy There are no standardized guidelines for managing pregnancy-associated decidual polyps. Compared with observation or conservative management, most clinicians prefer polypectomy. Considerations include: 1) Fragile polyps frequently cause recurrent or persistent bleeding, which often does not respond to conservative treatments (bed rest, oral progesterone, vaginal packing), potentially leading to maternal anemia, psychological anxiety, altered vaginal and cervical microenvironment, increased risk of ascending infection, chorioamnionitis, miscarriage, and preterm birth[ 17 , 18 ]; 2) Persistent vaginal bleeding may obscure other obstetric complications, such as placental abruption, necessitating polyp removal to control bleeding and identify the source; 3) Polyps > 3 cm in diameter located in the lower uterus or internal cervical canal may become incarcerated or compress gestational tissue, which may adversely affect pregnancy outcome; 4) Polypectomy helps exclude malignancy, though the risk is low. Surgical indications must be strictly assessed based on psychological impact, bleeding duration, and potential effects on pregnancy outcomes. In this study, all 38 patients had recurrent early-pregnancy bleeding poorly responsive to medication. Surgery was therefore recommended only for those with significant psychological distress, prolonged bleeding, or high risk of adverse pregnancy outcomes; for others without indications, conservative or expectant management was preferred. Advantages of Hysteroscopic Decidual Polypectomy During Pregnancy Traditionally, cervical polyps were removed using forceps, rotating the polyp stalk to detach it in one direction until avulsion occurs[ 19 ]. If bleeding occurs at the base, hemostatic gauze or sterile gauze packing can be applied for compression. This method is suitable for small or thin-stalked polyps, but for larger or thick-stalked polyps within the cervical canal, it can cause pain, significant bleeding, threatened miscarriage, and higher recurrence. Manipulation of the cervix may lead to uterine contractions, increasing maternal discomfort and miscarriage risk. Hysteroscopic resection of decidual polyps allows visualization of the polyps’ location and vascular supply within the cervical canal. The polyp can be completely excised using electrocautery approximately 1 cm below the internal cervical canal, enabling thorough removal of polypoid tissue. This approach significantly reduces recurrence rates and minimizes intraoperative and postoperative vaginal bleeding, making it an ideal treatment strategy for decidual polyps. Advantages include: 1) No need for cervical forceps or dilation, allowing rapid, safe removal with minimal bleeding using a 7 mm bipolar resectoscope. This technique not only facilitated convenient and efficient operation, shortening surgical time, but also ensured effective hemostasis, thereby reducing the incidence of postoperative vaginal bleeding and infection. 2) No entry into the uterine cavity, avoiding risks such as uterine perforation or fluid overload; 3) Bipolar current prevents electrical conduction through the maternal body and thus eliminating any risk of adverse effects on the fetus. Surgical key technical details involve: preoperatively, an experienced sonographer assessed the vascularity and location of the polyp within the cervical canal. The resection loop was introduced into the canal, and the polypectomy was performed at least 1 cm below the internal cervical canal. When encountering larger vessels, coagulation was applied prior to resection to ensure complete hemostasis. Limitations This study lacks large sample sizes and randomized controlled trials to fully compare this surgical method with others. Although hysteroscopic resection of decidual polyps is successful in most cases, variations in cervical anatomy, polyp location, and operator experience can lead to failure, with success rates of approximately 85–98%, requiring skilled surgeons[ 20 , 21 ]. Consequently, the technique demands a high degree of operational proficiency. All procedures in this study were performed by senior hysteroscopists with Level IV certification and over 8 years of experience, indicating potential barriers to widespread adoption. Conclusion Pregnancy complicated by decidual polyps carries a high risk of adverse outcomes. Surgical intervention should be carefully selected, based on symptom severity and patient psychological distress. For pregnant women presenting with recurrent vaginal bleeding due to decidual polyps, hysteroscopic polypectomy offers a painless, rapid, and precise approach for complete polyp resection with effective hemostasis. It represents a safe and effective surgical treatment for decidual polyps during pregnancy. However, broader clinical application requires further in-depth research and specialized training to optimize individualized care. Declarations Author contributions: Yi Yu: Experiment design, data organization, and paper writing. Dongdong Shi: Data collection and statistical analysis. Long Sui and Hongwei Zhang: Research design and guidance, paper modification. Limei Chen: Guarantor, research design and guidance, paper modification. All authors read and approved the final manuscript. Funding: The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not- for- profit sectors. Data availability: No datasets were generated or analysed during the study. Ethics approval and consent to participate: The study was approved by the Ethics Committee of the Obstetrics and Gynecology Hospital of Fudan University (approval number: 2023-12). All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. Participants gave informed consent to participate in the study before taking part. Consent for publication: Not applicable Competing interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest. References Tanos V, Berry KE, Seikkula J, Abi RE, Stavroulis A, Sleiman Z, Campo R, Gordts S: The management of polyps in female reproductive organs. INT J SURG 2017, 43:7-16. Zou J, He Y, Chen H, Wang P, Xiao X, Liu S: A Clinicopathologic Analysis of Decidual Polyps: A Potentially Problematic Diagnosis. INT J CLIN PRACT 2022, 2022:2200790. Wang M, Ye M, Shen N, Pan W, Zhang H, Wang X, Sun T, Zhou L, Meng Y: Management of pregnant women with endocervical and decidual polyps: a systematic review and meta-analysis. ARCH GYNECOL OBSTET 2025, 312(2):375-384. Riemma G, Della CL, Vitale SG, Cianci S, La Verde M, Giampaolino P, Cobellis L, De Franciscis P: Surgical management of endocervical and decidual polyps during pregnancy: systematic review and meta-analysis. ARCH GYNECOL OBSTET 2023, 307(3):673-680. Khan M, More A, Choudhary N, Chaudhary A: Plasma Rich in Growth Factor (PRGF) Therapy for Endometrial Receptivity: A Promising Approach in In vitro Fertilization (IVF) for Infertility with Uterine Polyps. J PHARM BIOALLIED SC 2025, 17(Suppl 1):S997-S999. Ji H, Zhou Q, Zhang S, Dong L, Zhao C, Ling XF: Different endometrial preparation protocols on first frozen-thawed embryo transfer outcomes after hysteroscopic polypectomy: A retrospective cohort study. INT J GYNECOL OBSTET 2024, 167(3):1152-1159. Zhang H, Wu L, Liao T, Wang R, Zhu H, Lin L, Wang W, Huang W: Clinical utility of office hysteroscopy following failed in vitro fertilization-embryo transfer: A retrospective cohort study. INT J GYNECOL OBSTET 2024, 166(3):1345-1350. Bolgarina Z, Desai HN, Senaratne M, Swami SS, Aye SL, Trivedi Y, Elshaikh AO: Cervical and Vaginal Deciduosis: Insights on Management and a Systematic Review of Observational Studies on Pregnancy Complications and Management Outcomes (Including Vaginal Birth). CUREUS J MED SCIENCE 2023, 15(8):e44479. Vitale SG, Haimovich S, Laganà AS, Alonso L, Di Spiezio SA, Carugno J: Endometrial polyps. An evidence-based diagnosis and management guide. EUR J OBSTET GYN R B 2021, 260:70-77. Seo N, Tachibana D, Misugi T, Koyama M, Tanaka S: First trimester findings of decidual polyp: Caution to avoid polypectomy. EUR J OBSTET GYN R B 2020, 249:109-110. Munro MG: Uterine polyps, adenomyosis, leiomyomas, and endometrial receptivity. FERTIL STERIL 2019, 111(4):629-640. Al CA, Saridogan E: Endometrial Polyps and Subfertility. J OBSTET GYN INDIA 2017, 67(1):9-14. Detti L, Peregrin-Alvarez I, Saed GM: Association between redundant endometrium and endometrial polyps: a pilot study. MINERVA OBSTET GYNEC 2023, 75(3):219-226. Lu H, Yang HL, Zhou WJ, Lai ZZ, Qiu XM, Fu Q, Zhao JY, Wang J, Li DJ, Li MQ: Rapamycin prevents spontaneous abortion by triggering decidual stromal cell autophagy-mediated NK cell residence. AUTOPHAGY 2021, 17(9):2511-2527. Mangla M, Nautiyal R, Shirazi N, Pati B: Ectopic Cervical Deciduosis: A Rare Cause of Antepartum Hemorrhage in Mid Trimester. EURASIAN J MED 2021, 53(2):152-154. Kondagari L, Josephs LS: Role of Ultrasound in Managing Cervical Polyps During Pregnancy. CUREUS J MED SCIENCE 2021, 13(10):e18702. Guzeloglu-Kayisli O, Kayisli UA, Semerci N, Basar M, Buchwalder LF, Buhimschi CS, Buhimschi IA, Arcuri F, Larsen K, Huang JS et al : Mechanisms of chorioamnionitis-associated preterm birth: interleukin-1β inhibits progesterone receptor expression in decidual cells. J PATHOL 2015, 237(4):423-434. Tokunaka M, Hasegawa J, Oba T, Nakamura M, Matsuoka R, Ichizuka K, Otsuki K, Okai T, Sekizawa A: Decidual polyps are associated with preterm delivery in cases of attempted uterine cervical polypectomy during the first and second trimester. J MATERN-FETAL NEO M 2015, 28(9):1061-1063. Baker E, MacDonald A, Tennant S: Approach to cervical polyps in primary care. CAN FAM PHYSICIAN 2025, 71(1):26-30. Zhang L, Feng L: Application of hysteroscopy in female fertility preservation. Zhong Nan Da Xue Xue Bao Yi Xue Ban 2022, 47(11):1472-1478. Li H, Yang B, Gao W, Huang C, Li C, Zhao H, Feng L: Role of surgical vaginoscopy through no-touch hysteroscope in the treatment of female reproductive polyps. BMC SURG 2024, 24(1):390. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Published Journal Publication published 08 Jan, 2026 Read the published version in BMC Pregnancy and Childbirth → Version 1 posted Editorial decision: Revision requested 23 Oct, 2025 Reviews received at journal 18 Oct, 2025 Reviews received at journal 13 Oct, 2025 Reviewers agreed at journal 09 Oct, 2025 Reviews received at journal 08 Oct, 2025 Reviewers agreed at journal 07 Oct, 2025 Reviewers agreed at journal 07 Oct, 2025 Reviewers invited by journal 07 Oct, 2025 Editor invited by journal 22 Sep, 2025 Editor assigned by journal 19 Sep, 2025 Submission checks completed at journal 19 Sep, 2025 First submitted to journal 16 Sep, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. 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15:55:20","extension":"png","order_by":11,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":1449592,"visible":true,"origin":"","legend":"","description":"","filename":"floatimage2.png","url":"https://assets-eu.researchsquare.com/files/rs-7627647/v1/a9f8082da293ef3d58023224.png"},{"id":93797755,"identity":"726c0dd9-be9f-445f-b57e-5dbe5f127b46","added_by":"auto","created_at":"2025-10-17 16:03:20","extension":"png","order_by":12,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":85874,"visible":true,"origin":"","legend":"","description":"","filename":"Onlinefigure1.png","url":"https://assets-eu.researchsquare.com/files/rs-7627647/v1/949d6d143df348658867092f.png"},{"id":93797060,"identity":"ab521b30-4f23-4872-94d6-cbceade10b2e","added_by":"auto","created_at":"2025-10-17 15:55:20","extension":"png","order_by":13,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":116130,"visible":true,"origin":"","legend":"","description":"","filename":"Onlinefigure2.png","url":"https://assets-eu.researchsquare.com/files/rs-7627647/v1/0fa70cedbf5e0b29d8232977.png"},{"id":93797062,"identity":"959568e0-d2f9-44d6-9327-bba42c109a7b","added_by":"auto","created_at":"2025-10-17 15:55:20","extension":"png","order_by":14,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":168000,"visible":true,"origin":"","legend":"","description":"","filename":"Onlinefloatimage1.png","url":"https://assets-eu.researchsquare.com/files/rs-7627647/v1/0c1996f5c47eb3ead9348021.png"},{"id":93797059,"identity":"7e6c2fc4-a78c-4263-8bee-00a673b14cf8","added_by":"auto","created_at":"2025-10-17 15:55:20","extension":"png","order_by":15,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":254055,"visible":true,"origin":"","legend":"","description":"","filename":"Onlinefloatimage2.png","url":"https://assets-eu.researchsquare.com/files/rs-7627647/v1/2d7684d0728aaa631116ce09.png"},{"id":93797065,"identity":"ab00e6a1-a50b-43e3-9cf6-4d00b1164a5e","added_by":"auto","created_at":"2025-10-17 15:55:20","extension":"xml","order_by":16,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":73186,"visible":true,"origin":"","legend":"","description":"","filename":"7fff119e2748422f9c6290ccf46e8ad11structuring.xml","url":"https://assets-eu.researchsquare.com/files/rs-7627647/v1/06dd646d470f9a52afe2400f.xml"},{"id":93797064,"identity":"fd6c9a9a-6974-444a-87b7-43e7bdc49530","added_by":"auto","created_at":"2025-10-17 15:55:20","extension":"html","order_by":17,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":80459,"visible":true,"origin":"","legend":"","description":"","filename":"earlyproof.html","url":"https://assets-eu.researchsquare.com/files/rs-7627647/v1/407dfb2a576649491ba45c84.html"},{"id":93797748,"identity":"22cac2b5-899e-4309-88ab-117947fdeb84","added_by":"auto","created_at":"2025-10-17 16:03:20","extension":"jpg","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":91286,"visible":true,"origin":"","legend":"\u003cp\u003eA: Under hysteroscopic direct vision, the hysteroscope was inserted into the endocervical canal through the external cervical canal. B: The polyp pedicle was resected using a bipolar resectoscope loop approximately 1 cm below the internal cervical canal. C: Bleeding occurred during the resection; hemostasis was achieved by coagulating the large blood vessels during resection; the hysteroscope was withdrawn after complete transection of the pedicle.\u003c/p\u003e","description":"","filename":"figure1.jpg","url":"https://assets-eu.researchsquare.com/files/rs-7627647/v1/bb37db6d79b947b436e0c68a.jpg"},{"id":93797049,"identity":"48717124-19a2-4020-91f8-29b7a6712ee3","added_by":"auto","created_at":"2025-10-17 15:55:20","extension":"jpg","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":128465,"visible":true,"origin":"","legend":"\u003cp\u003eA: Ultrasonographic image of a decidual polyp at 7 weeks of gestation, showing the polyp extending through the endocervical canal. B: Gross appearance of the decidual polyp, which presented with marked hyperemia, a broad pedicle, and localized coverage of purulent exudate membrane. C: Microscopic view revealing decidual cells arranged in a mosaic pattern, with abundant pale or vacuolated cytoplasm and centrally located nuclei (HE staining, ×100).\u003c/p\u003e","description":"","filename":"figure2.jpg","url":"https://assets-eu.researchsquare.com/files/rs-7627647/v1/ca95ee4f30922d108b61ea02.jpg"},{"id":100069100,"identity":"708ebfcc-af65-4fa9-8d94-3ec7eecce148","added_by":"auto","created_at":"2026-01-12 16:09:22","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":823316,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7627647/v1/5097d812-fa3d-48cd-90b4-9fdcd72e6116.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Clinical application of hysteroscopic decidual polypectomy in pregnant women","fulltext":[{"header":"Introduction","content":"\u003cp\u003eDecidual polyps, also referred to as decidual prolapse, are characterized by the hyperplasia and edema of uterine decidua, which prolapses through the external cervical canal[\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. Typical decidual polyps are observed exclusively in pregnant women, while a few atypical cases of decidual reaction polyps have been reported in non-pregnant individuals receiving long-term progestin therapy[\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. The prevalence is low, and literature is scarce, limited to case reports and small case series. In recent years, there has been a notable increase in the number of patients diagnosed with pregnancy complicated by decidual polyps, likely related to more patients undergoing \u003cem\u003ein vitro\u003c/em\u003e fertilization and embryo transfer (IVF-ET) or receiving progestin therapy for threatened miscarriage, attracting clinical attention[\u003cspan additionalcitationids=\"CR6\" citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. Decidual polyps extend throughout the cervical canal, disrupting the natural cervical barrier, and are highly susceptible to bleeding and necrosis, markedly increasing the risks of intrauterine infection, miscarriage, and preterm birth[\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eCurrently, there is no unified recommendation for the management of decidual polyps during pregnancy. Indications for surgery should be carefully assessed, considering patient psychological status, bleeding duration, and impact on pregnancy outcomes[\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e, \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]. This study retrospectively analyzed the clinical data of 38 patients with recurrent vaginal bleeding due to decidual polyps during pregnancy who underwent hysteroscopic resection after poor response to conservative medical treatment. The surgical methods, timing of intervention, and subsequent pregnancy outcomes were evaluated to investigate the clinical efficacy and safety of hysteroscopic polypectomy in pregnant women.\u003c/p\u003e"},{"header":"Materials and Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e\u003ch2\u003ePatients and procedure\u003c/h2\u003e\u003cp\u003eThis study was a retrospective investigation conducted at the Hysteroscopic Center, Obstetrics and Gynecology Hospital of Fudan University. The study was approved by the Ethics Committee of the Obstetrics and Gynecology Hospital of Fudan University (approval number: 2023-12) and we confirm that the methods used in the study comply with the relevant guidelines and regulations. The study cohort comprised 38 patients who underwent hysteroscopic resection of decidual polyps during pregnancy at our hospital between January 2023 and January 2025. All participants had undergone cervical cytology screening (ThinPrep Cytologic Test, TCT) and human papillomavirus (HPV) testing either prior to pregnancy or during early gestation to exclude cervical lesions.\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eInclusion criteria\u003c/strong\u003e\u003cp\u003e(1) Age 18\u0026ndash;40 years; (2) Intrauterine viable pregnancy confirmed by ultrasound with recurrent vaginal bleeding during pregnancy; (3) Presence of polypoid cervical lesions confirmed by gynecologic examination.\u003c/p\u003e\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eExclusion criteria\u003c/strong\u003e\u003cp\u003eUse of medications during pregnancy that may affect pregnancy outcomes, severe hepatic or renal dysfunction, cardiopulmonary insufficiency, or significant psychiatric or behavioral disorders.\u003c/p\u003e\u003c/p\u003e\u003cp\u003eAll enrolled patients underwent systematic evaluation in the Cervical Disease Clinic and Obstetrics Clinic prior to admission. They were thoroughly informed about potential risks associated with the procedure, including secondary hemorrhage, infection, and possible induction of abortion. All patients acknowledged understanding the treatment details and provided written informed consent. Prior to the procedure, cervical secretion cultures were performed. Surgery was conducted if the culture result was negative; if positive, sensitive antibiotic treatment was administered first, followed by the operation.\u003c/p\u003e\u003c/div\u003e\n\u003ch3\u003eHysteroscopy\u003c/h3\u003e\n\u003cp\u003ePrior to the procedure, the location of hypervascular areas within the polyp must be identified by an experienced ultrasonographer. The patient was placed in the lithotomy position, and after general anesthesia, the vulva and vagina were disinfected and draped. Cervical dilation with a speculum was not required. A 7-mm bipolar resectoscope was used, with 0.9% sodium chloride injection as the distension medium. Intrauterine pressure was maintained below 80 mmHg (1 mmHg\u0026thinsp;=\u0026thinsp;0.133 kPa) to minimize the inflow of saline into the uterine cavity and reduce the risk of infection.\u003c/p\u003e\u003cp\u003eUnder direct hysteroscopic visualization, the resectoscope was inserted into the cervical canal (Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e1\u003c/span\u003eA). The pedicle of the polyp was resected using a bipolar loop approximately 1 cm below the level of the internal cervical canal (Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e1\u003c/span\u003eB). In cases of bleeding during resection, the bipolar loop was used for coagulation to achieve hemostasis. The hysteroscope was withdrawn after complete transection of the pedicle (Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e1\u003c/span\u003eC), and the procedure was concluded once hemostasis was confirmed. The procedure was concluded once hemostasis was confirmed. Both resection and coagulation were performed at a power setting of 30 W, with a flow rate of 300 ml/min. Prophylactic antibiotics were administered for 24 hours postoperatively. All hysteroscopic procedures in this study were performed by senior hysteroscopists with Level IV certification and over 8 years of experience.\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\n\u003ch3\u003eEvaluation indicators\u003c/h3\u003e\n\u003cp\u003eThe following parameters were recorded: operative time, intraoperative blood loss, postoperative pathology, perioperative complications, recurrent bleeding during pregnancy, mode of delivery, gestational age at delivery, and outcomes through the puerperium. Patient satisfaction and adverse events were also documented.\u003c/p\u003e\u003cdiv id=\"Sec6\" class=\"Section2\"\u003e\u003ch2\u003eStatistical analysis\u003c/h2\u003e\u003cp\u003eStatistical analysis was performed using SPSS 17.0. The Kolmogorov-Smirnov test was used to assess the normality of continuous variables. Normally distributed data were presented as mean\u0026thinsp;\u0026plusmn;\u0026thinsp;standard deviation (x\u0026thinsp;\u0026plusmn;\u0026thinsp;s), while non-normally distributed data were expressed as median and interquartile range [M (Q1, Q3)]. Continuous variables were compared before and after treatment using the t-test. Categorical variables were summarized as n (%). A p-value\u0026thinsp;\u0026lt;\u0026thinsp;0.05 was considered statistically significant.\u003c/p\u003e\u003c/div\u003e"},{"header":"Results","content":"\u003cdiv id=\"Sec8\" class=\"Section2\"\u003e\u003ch2\u003eGeneral parameters\u003c/h2\u003e\u003cp\u003eA total of 38 patients were enrolled, with a mean age of 28.7\u0026thinsp;\u0026plusmn;\u0026thinsp;2.4 years (range: 23\u0026ndash;39 years). Among them, 31 were primiparous and 7 were multiparous. The gestational age at surgery ranged from 8 to 19 weeks, with a mean of 11.0\u0026thinsp;\u0026plusmn;\u0026thinsp;3.2 weeks. All patients presented with recurrent vaginal bleeding during pregnancy, and the time from symptom onset to surgery ranged from 6 hours to 7 days. Preoperative ultrasonography revealed a hypoechoic mass located above the internal cervical canal, extending to the external cervical canal in all cases (Fig.\u0026nbsp;\u003cspan refid=\"Fig3\" class=\"InternalRef\"\u003e2\u003c/span\u003eA). Gynecological examination confirmed the presence of polypoid tissue at the external cervical canal in all patients (Fig.\u0026nbsp;\u003cspan refid=\"Fig3\" class=\"InternalRef\"\u003e2\u003c/span\u003eB). The polyp diameter ranged from 1.4 to 5.5 cm, with a mean diameter of 3.82\u0026thinsp;\u0026plusmn;\u0026thinsp;1.50 cm; 22 patients had polyps\u0026thinsp;\u0026ge;\u0026thinsp;3 cm (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eBaseline characteristics of patients\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"2\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCharacteristics\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eResults\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAge(years)(mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e28.7\u0026thinsp;\u0026plusmn;\u0026thinsp;2.4\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eParity [M(Q1,Q3)]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0 (0,1)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePolyp size (mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e3.82\u0026thinsp;\u0026plusmn;\u0026thinsp;1.50\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eGestational weeks of polypectomy\u003c/p\u003e\u003cp\u003e(mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e11.0\u0026thinsp;\u0026plusmn;\u0026thinsp;3.2\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eVaginal bleeding pre-operation(n)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e48\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003c/div\u003e\n\u003ch3\u003eHysteroscopy\u003c/h3\u003e\n\u003cp\u003eAll 38 pregnant patients successfully underwent hysteroscopic removal of decidual polyps.\u003c/p\u003e\u003cp\u003eOperation time ranged from 4 to 10 minutes (mean 5.43\u0026thinsp;\u0026plusmn;\u0026thinsp;1.42 minutes), with intraoperative blood loss of 0\u0026ndash;5 ml (mean 0.53\u0026thinsp;\u0026plusmn;\u0026thinsp;0.49 ml). No complications such as uterine perforation, massive bleeding, fluid overload, or postoperative infection occurred.\u003c/p\u003e\n\u003ch3\u003ePostoperative Outcomes and Pregnancy Results\u003c/h3\u003e\n\u003cp\u003ePostoperative pathological examination confirmed the diagnosis of decidual polyp in all cases (Fig.\u0026nbsp;\u003cspan refid=\"Fig3\" class=\"InternalRef\"\u003e2\u003c/span\u003eC). None of the patients experienced recurrent bleeding after surgery (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e). Of the 37 patients who completed pregnancy, the full-term delivery rate was 94.6% (35/38), with gestational age at delivery ranging from 37 to 41 weeks (mean 39.12\u0026thinsp;\u0026plusmn;\u0026thinsp;1.02 weeks); 26 delivered vaginally, 8 by cesarean section, and 1 by forceps-assisted delivery. The spontaneous abortion rate was 2.6% (1/38); this patient experienced inevitable miscarriage at 24 weeks, with pathology showing decidual polyp and placental pathology revealing chorioamnionitis. Preterm birth occurred in 5.3% (2/38); one patient delivered at 36 weeks by cesarean due to preterm premature rupture of membranes (preoperative cervical cultures were negative), and one delivered at 32 weeks, with a history of cervical conization. Patients with decidual polyps\u0026thinsp;\u0026ge;\u0026thinsp;3 cm had a higher probability of successful full-term pregnancy than those with polyps\u0026thinsp;\u0026lt;\u0026thinsp;3 cm (21/22 vs. 14/16), though the difference was not statistically significant (P\u0026thinsp;=\u0026thinsp;0.069).\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eThe pregnancy and neonatal outcomes of patients\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"2\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePregnancy outcomes\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eResults\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eVaginal bleeding post-operation(n)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eGestational weeks at delivery (mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e39.12\u0026thinsp;\u0026plusmn;\u0026thinsp;1.02\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eFull-term birth[n(%)]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e35(94.6)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCesarean section\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e8(21.1)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSpontaneous abortion[n(%)]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1(2.6)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePreterm birth[n(%)]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e2(5.3)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNeonatal birth weight (Kg, mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e2.98\u0026thinsp;\u0026plusmn;\u0026thinsp;0.85\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eApgar score [M(Q1, Q3)])\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e1 minute\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e10.0(10\u0026thinsp;~\u0026thinsp;10)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e5 minute\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e10.0(10\u0026thinsp;~\u0026thinsp;10)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e10 minute\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e10.0(10\u0026thinsp;~\u0026thinsp;10)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e"},{"header":"Discussion","content":"\u003cdiv id=\"Sec12\" class=\"Section2\"\u003e\u003ch2\u003eCharacteristics of Decidual Polyps During Pregnancy\u003c/h2\u003e\u003cp\u003eDecidual polyps are most frequently observed in the first and second trimesters of pregnancy and represent a relatively common type of polyp during gestation, aside from cervical polyps. The exact pathogenesis remains unclear; however, several studies suggest that decidual polyps represent a specific morphological change in the endometrial tissue during pregnancy[\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e, \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. Elevated hormone levels and abundant blood supply during gestation promote hyperplasia of endometrial glands, which can cause existing or newly formed cervical polyps to rapidly enlarge and protrude through the external cervical canal, forming decidual polyps. In recent years, with an increase in patients undergoing assisted reproduction and receiving high doses of estrogen and progesterone, the incidence of pregnancy complicated by decidual polyps has risen. Morphologically, decidual polyps are tongue- or polyp-shaped, fragile, and prone to bleeding. Histologically, glands are diffusely distributed, stromal cells show decidual changes, and inflammation, hemorrhage, necrosis, or thrombosis may be present. Polyps can be solitary or multiple and are difficult to distinguish from cervical polyps macroscopically. Pathological terminology varies, including \u0026ldquo;cervical polyp with decidual change,\u0026rdquo; \u0026ldquo;decidual fragment,\u0026rdquo; or \u0026ldquo;endometrial polyp with decidual change\u0026rdquo;[\u003cspan additionalcitationids=\"CR14\" citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e].\u003c/p\u003e\u003cp\u003ePregnancy-associated decidual polyps often present as painless vaginal bleeding; therefore, first-trimester vaginal bleeding should not be immediately diagnosed as threatened or inevitable miscarriage, and vaginal examination is required for definitive diagnosis. Compared with cervical polyps, decidual polyps are more fragile and prone to contact bleeding, often with purulent secretions on the surface. Ultrasound may show polyps extending from the uterine cavity downward through the cervical canal[\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]. Definitive diagnosis requires histopathology.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec13\" class=\"Section2\"\u003e\u003ch2\u003eSurgical Indications for Decidual Polyps During Pregnancy\u003c/h2\u003e\u003cp\u003e There are no standardized guidelines for managing pregnancy-associated decidual polyps. Compared with observation or conservative management, most clinicians prefer polypectomy. Considerations include: 1) Fragile polyps frequently cause recurrent or persistent bleeding, which often does not respond to conservative treatments (bed rest, oral progesterone, vaginal packing), potentially leading to maternal anemia, psychological anxiety, altered vaginal and cervical microenvironment, increased risk of ascending infection, chorioamnionitis, miscarriage, and preterm birth[\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e, \u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]; 2) Persistent vaginal bleeding may obscure other obstetric complications, such as placental abruption, necessitating polyp removal to control bleeding and identify the source; 3) Polyps\u0026thinsp;\u0026gt;\u0026thinsp;3 cm in diameter located in the lower uterus or internal cervical canal may become incarcerated or compress gestational tissue, which may adversely affect pregnancy outcome; 4) Polypectomy helps exclude malignancy, though the risk is low.\u003c/p\u003e\u003cp\u003eSurgical indications must be strictly assessed based on psychological impact, bleeding duration, and potential effects on pregnancy outcomes. In this study, all 38 patients had recurrent early-pregnancy bleeding poorly responsive to medication. Surgery was therefore recommended only for those with significant psychological distress, prolonged bleeding, or high risk of adverse pregnancy outcomes; for others without indications, conservative or expectant management was preferred.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec14\" class=\"Section2\"\u003e\u003ch2\u003eAdvantages of Hysteroscopic Decidual Polypectomy During Pregnancy\u003c/h2\u003e\u003cp\u003eTraditionally, cervical polyps were removed using forceps, rotating the polyp stalk to detach it in one direction until avulsion occurs[\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]. If bleeding occurs at the base, hemostatic gauze or sterile gauze packing can be applied for compression. This method is suitable for small or thin-stalked polyps, but for larger or thick-stalked polyps within the cervical canal, it can cause pain, significant bleeding, threatened miscarriage, and higher recurrence. Manipulation of the cervix may lead to uterine contractions, increasing maternal discomfort and miscarriage risk.\u003c/p\u003e\u003cp\u003eHysteroscopic resection of decidual polyps allows visualization of the polyps\u0026rsquo; location and vascular supply within the cervical canal. The polyp can be completely excised using electrocautery approximately 1 cm below the internal cervical canal, enabling thorough removal of polypoid tissue. This approach significantly reduces recurrence rates and minimizes intraoperative and postoperative vaginal bleeding, making it an ideal treatment strategy for decidual polyps.\u003c/p\u003e\u003cp\u003eAdvantages include: 1) No need for cervical forceps or dilation, allowing rapid, safe removal with minimal bleeding using a 7 mm bipolar resectoscope. This technique not only facilitated convenient and efficient operation, shortening surgical time, but also ensured effective hemostasis, thereby reducing the incidence of postoperative vaginal bleeding and infection. 2) No entry into the uterine cavity, avoiding risks such as uterine perforation or fluid overload; 3) Bipolar current prevents electrical conduction through the maternal body and thus eliminating any risk of adverse effects on the fetus. Surgical key technical details involve: preoperatively, an experienced sonographer assessed the vascularity and location of the polyp within the cervical canal. The resection loop was introduced into the canal, and the polypectomy was performed at least 1 cm below the internal cervical canal. When encountering larger vessels, coagulation was applied prior to resection to ensure complete hemostasis.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec15\" class=\"Section2\"\u003e\u003ch2\u003eLimitations\u003c/h2\u003e\u003cp\u003eThis study lacks large sample sizes and randomized controlled trials to fully compare this surgical method with others. Although hysteroscopic resection of decidual polyps is successful in most cases, variations in cervical anatomy, polyp location, and operator experience can lead to failure, with success rates of approximately 85\u0026ndash;98%, requiring skilled surgeons[\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e, \u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e]. Consequently, the technique demands a high degree of operational proficiency. All procedures in this study were performed by senior hysteroscopists with Level IV certification and over 8 years of experience, indicating potential barriers to widespread adoption.\u003c/p\u003e\u003c/div\u003e"},{"header":"Conclusion","content":"\u003cp\u003ePregnancy complicated by decidual polyps carries a high risk of adverse outcomes. Surgical intervention should be carefully selected, based on symptom severity and patient psychological distress. For pregnant women presenting with recurrent vaginal bleeding due to decidual polyps, hysteroscopic polypectomy offers a painless, rapid, and precise approach for complete polyp resection with effective hemostasis. It represents a safe and effective surgical treatment for decidual polyps during pregnancy. However, broader clinical application requires further in-depth research and specialized training to optimize individualized care.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eAuthor contributions:\u003c/strong\u003e Yi Yu: Experiment design, data organization, and paper writing. Dongdong Shi: Data collection and statistical analysis. Long Sui and Hongwei Zhang: Research design and guidance, paper modification. Limei Chen: Guarantor, research design and guidance, paper modification. All authors read and approved the final manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding:\u003c/strong\u003e The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not- for- profit sectors.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData availability:\u0026nbsp;\u003c/strong\u003eNo datasets were generated or analysed during the study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate:\u0026nbsp;\u003c/strong\u003eThe study was approved by the Ethics Committee of the Obstetrics and Gynecology Hospital of Fudan University (approval number: 2023-12). All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. Participants gave informed consent to participate in the study before taking part.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication:\u0026nbsp;\u003c/strong\u003eNot applicable\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests:\u0026nbsp;\u003c/strong\u003eThe authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.\u003c/p\u003e\n"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eTanos V, Berry KE, Seikkula J, Abi RE, Stavroulis A, Sleiman Z, Campo R, Gordts S: The management of polyps in female reproductive organs. \u003cem\u003eINT J SURG\u003c/em\u003e 2017, 43:7-16.\u003c/li\u003e\n\u003cli\u003eZou J, He Y, Chen H, Wang P, Xiao X, Liu S: A Clinicopathologic Analysis of Decidual Polyps: A Potentially Problematic Diagnosis. \u003cem\u003eINT J CLIN PRACT\u003c/em\u003e 2022, 2022:2200790.\u003c/li\u003e\n\u003cli\u003eWang M, Ye M, Shen N, Pan W, Zhang H, Wang X, Sun T, Zhou L, Meng Y: Management of pregnant women with endocervical and decidual polyps: a systematic review and meta-analysis. \u003cem\u003eARCH GYNECOL OBSTET\u003c/em\u003e 2025, 312(2):375-384.\u003c/li\u003e\n\u003cli\u003eRiemma G, Della CL, Vitale SG, Cianci S, La Verde M, Giampaolino P, Cobellis L, De Franciscis P: Surgical management of endocervical and decidual polyps during pregnancy: systematic review and meta-analysis. \u003cem\u003eARCH GYNECOL OBSTET\u003c/em\u003e 2023, 307(3):673-680.\u003c/li\u003e\n\u003cli\u003eKhan M, More A, Choudhary N, Chaudhary A: Plasma Rich in Growth Factor (PRGF) Therapy for Endometrial Receptivity: A Promising Approach in In vitro Fertilization (IVF) for Infertility with Uterine Polyps. \u003cem\u003eJ PHARM BIOALLIED SC\u003c/em\u003e 2025, 17(Suppl 1):S997-S999.\u003c/li\u003e\n\u003cli\u003eJi H, Zhou Q, Zhang S, Dong L, Zhao C, Ling XF: Different endometrial preparation protocols on first frozen-thawed embryo transfer outcomes after hysteroscopic polypectomy: A retrospective cohort study. \u003cem\u003eINT J GYNECOL OBSTET\u003c/em\u003e 2024, 167(3):1152-1159.\u003c/li\u003e\n\u003cli\u003eZhang H, Wu L, Liao T, Wang R, Zhu H, Lin L, Wang W, Huang W: Clinical utility of office hysteroscopy following failed in vitro fertilization-embryo transfer: A retrospective cohort study. \u003cem\u003eINT J GYNECOL OBSTET\u003c/em\u003e 2024, 166(3):1345-1350.\u003c/li\u003e\n\u003cli\u003eBolgarina Z, Desai HN, Senaratne M, Swami SS, Aye SL, Trivedi Y, Elshaikh AO: Cervical and Vaginal Deciduosis: Insights on Management and a Systematic Review of Observational Studies on Pregnancy Complications and Management Outcomes (Including Vaginal Birth). \u003cem\u003eCUREUS J MED SCIENCE\u003c/em\u003e 2023, 15(8):e44479.\u003c/li\u003e\n\u003cli\u003eVitale SG, Haimovich S, Lagan\u0026agrave; AS, Alonso L, Di Spiezio SA, Carugno J: Endometrial polyps. An evidence-based diagnosis and management guide. \u003cem\u003eEUR J OBSTET GYN R B\u003c/em\u003e 2021, 260:70-77.\u003c/li\u003e\n\u003cli\u003eSeo N, Tachibana D, Misugi T, Koyama M, Tanaka S: First trimester findings of decidual polyp: Caution to avoid polypectomy. \u003cem\u003eEUR J OBSTET GYN R B\u003c/em\u003e 2020, 249:109-110.\u003c/li\u003e\n\u003cli\u003eMunro MG: Uterine polyps, adenomyosis, leiomyomas, and endometrial receptivity. \u003cem\u003eFERTIL STERIL\u003c/em\u003e 2019, 111(4):629-640.\u003c/li\u003e\n\u003cli\u003eAl CA, Saridogan E: Endometrial Polyps and Subfertility. \u003cem\u003eJ OBSTET GYN INDIA\u003c/em\u003e 2017, 67(1):9-14.\u003c/li\u003e\n\u003cli\u003eDetti L, Peregrin-Alvarez I, Saed GM: Association between redundant endometrium and endometrial polyps: a pilot study. \u003cem\u003eMINERVA OBSTET GYNEC\u003c/em\u003e 2023, 75(3):219-226.\u003c/li\u003e\n\u003cli\u003eLu H, Yang HL, Zhou WJ, Lai ZZ, Qiu XM, Fu Q, Zhao JY, Wang J, Li DJ, Li MQ: Rapamycin prevents spontaneous abortion by triggering decidual stromal cell autophagy-mediated NK cell residence. \u003cem\u003eAUTOPHAGY\u003c/em\u003e 2021, 17(9):2511-2527.\u003c/li\u003e\n\u003cli\u003eMangla M, Nautiyal R, Shirazi N, Pati B: Ectopic Cervical Deciduosis: A Rare Cause of Antepartum Hemorrhage in Mid Trimester. \u003cem\u003eEURASIAN J MED\u003c/em\u003e 2021, 53(2):152-154.\u003c/li\u003e\n\u003cli\u003eKondagari L, Josephs LS: Role of Ultrasound in Managing Cervical Polyps During Pregnancy. \u003cem\u003eCUREUS J MED SCIENCE\u003c/em\u003e 2021, 13(10):e18702.\u003c/li\u003e\n\u003cli\u003eGuzeloglu-Kayisli O, Kayisli UA, Semerci N, Basar M, Buchwalder LF, Buhimschi CS, Buhimschi IA, Arcuri F, Larsen K, Huang JS\u003cem\u003e et al\u003c/em\u003e: Mechanisms of chorioamnionitis-associated preterm birth: interleukin-1\u0026beta; inhibits progesterone receptor expression in decidual cells. \u003cem\u003eJ PATHOL\u003c/em\u003e 2015, 237(4):423-434.\u003c/li\u003e\n\u003cli\u003eTokunaka M, Hasegawa J, Oba T, Nakamura M, Matsuoka R, Ichizuka K, Otsuki K, Okai T, Sekizawa A: Decidual polyps are associated with preterm delivery in cases of attempted uterine cervical polypectomy during the first and second trimester. \u003cem\u003eJ MATERN-FETAL NEO M\u003c/em\u003e 2015, 28(9):1061-1063.\u003c/li\u003e\n\u003cli\u003eBaker E, MacDonald A, Tennant S: Approach to cervical polyps in primary care. \u003cem\u003eCAN FAM PHYSICIAN\u003c/em\u003e 2025, 71(1):26-30.\u003c/li\u003e\n\u003cli\u003eZhang L, Feng L: Application of hysteroscopy in female fertility preservation. \u003cem\u003eZhong Nan Da Xue Xue Bao Yi Xue Ban\u003c/em\u003e 2022, 47(11):1472-1478.\u003c/li\u003e\n\u003cli\u003eLi H, Yang B, Gao W, Huang C, Li C, Zhao H, Feng L: Role of surgical vaginoscopy through no-touch hysteroscope in the treatment of female reproductive polyps. \u003cem\u003eBMC SURG\u003c/em\u003e 2024, 24(1):390.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-pregnancy-and-childbirth","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"prch","sideBox":"Learn more about [BMC Pregnancy and Childbirth](http://bmcpregnancychildbirth.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/prch/default.aspx","title":"BMC Pregnancy and Childbirth","twitterHandle":"@BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Hysteroscopy, Pregnancy, Decidual polyp, Pregnancy outcomes","lastPublishedDoi":"10.21203/rs.3.rs-7627647/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7627647/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eObjective:\u003c/strong\u003eThis study aims to explore the clinical efficacy and safety of hysteroscopic decidua polypectomy during pregnancy.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods:\u003c/strong\u003e This retrospective study analyzed 38 patients presenting with recurrent vaginal bleeding due to pregnancy-associated decidual polyps who underwent hysteroscopic polypectomy at the Obstetrics and Gynecology Hospital of Fudan University from January 2023 to January 2025. Data on surgical techniques, timing of intervention, and subsequent pregnancy outcomes were evaluated.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults:\u003c/strong\u003e A total of 38 patients who underwent hysteroscopic decidual polypectomy were included in this study, with an age range of 23-39 years (mean 28.7 ± 2.4 years). Among them, 31 were primiparous and 7 were multiparous. The gestational age at surgery ranged from 8 to 19 weeks (mean 11.0 ± 3.2 weeks). All 38 patients presented with recurrent vaginal bleeding during pregnancy. The polyp diameter ranged from 1.4 to 5.5 cm (mean 3.82 ± 1.50 cm), with 22 cases (57.9%) having a diameter greater than 3 cm. All 38 patients successfully underwent hysteroscopic resection. The operative time ranged from 4 to 10 minutes (mean 5.43 ± 1.42 minutes), , with intraoperative blood loss of 0–5 ml (mean 2.53 ± 0.49 ml). No patient experienced postoperative rebleeding or any perioperative complications. Of the 38 patients, 37completed pregnancy; the full-term delivery rate was 94.6% (35/38), with gestational age at delivery of 37–41.4 weeks (mean 39.12 ± 1.02 weeks). Among these, 26 spontaneous vaginal deliveries, 8 cesarean sections, and 1 forceps delivery. The preterm birth rate was 5.3% (2/38), and the spontaneous abortion rate was 2.6% (1/38).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion:\u003c/strong\u003e Hysteroscopy allows for painless, rapid, and precise resection of decidual polyps with effective hemostasis. It represents a safe and effective surgical approach for treating decidual polyps during pregnancy, but should be performed by experienced hysteroscopists to ensure optimal outcomes.\u003c/p\u003e","manuscriptTitle":"Clinical application of hysteroscopic decidual polypectomy in pregnant women","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-10-17 15:55:15","doi":"10.21203/rs.3.rs-7627647/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2025-10-23T09:40:32+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-10-19T02:09:34+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-10-13T15:23:12+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"336936365097504350869893086040862363298","date":"2025-10-09T12:07:22+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-10-08T14:54:34+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"172032273675623217494895724486544639953","date":"2025-10-07T13:34:06+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"122024202513089537808638696925932041400","date":"2025-10-07T07:52:52+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-10-07T07:07:33+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2025-09-22T08:51:56+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-09-19T11:29:20+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-09-19T11:28:08+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Pregnancy and Childbirth","date":"2025-09-16T08:02:35+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-pregnancy-and-childbirth","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"prch","sideBox":"Learn more about [BMC Pregnancy and Childbirth](http://bmcpregnancychildbirth.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/prch/default.aspx","title":"BMC Pregnancy and Childbirth","twitterHandle":"@BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"7aa4e4ff-4ed6-4cfa-809c-0bfa08fb82e2","owner":[],"postedDate":"October 17th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2026-01-12T16:01:06+00:00","versionOfRecord":{"articleIdentity":"rs-7627647","link":"https://doi.org/10.1186/s12884-025-08605-w","journal":{"identity":"bmc-pregnancy-and-childbirth","isVorOnly":false,"title":"BMC Pregnancy and Childbirth"},"publishedOn":"2026-01-08 15:57:29","publishedOnDateReadable":"January 8th, 2026"},"versionCreatedAt":"2025-10-17 15:55:15","video":"","vorDoi":"10.1186/s12884-025-08605-w","vorDoiUrl":"https://doi.org/10.1186/s12884-025-08605-w","workflowStages":[]},"version":"v1","identity":"rs-7627647","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7627647","identity":"rs-7627647","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}