Cervical deciduosis imitating dysplasia

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

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.

Ectopic Cervical Deciduosis: A Rare Cause of Antepartum Hemorrhage in Mid Trimester

Decidual change is a key process required by the uterus to make itself ready for implantation. Presence of ectopic decidual tissue outside the uterine cavity is known as deciduosis. The clinical presentation can vary from being totally asymptomatic and subtle to presenting in the form of life-threatening emergencies like hemoperitoneum, recurrent pneumothorax, or even bowel perforation. Here, we present a case of ectopic deciduosis of cervix presenting in the form of severe life-threatening antepartum hemorrhage in second trimester of pregnancy.