Rafaelano MAJ, Salazar VF, Morales FI, Zuno CTT, Tolentino SMI

Language: Spanish
References: 15
Page: 327-332
PDF size: 326.90 Kb.

ABSTRACT

Introduction: A placental polyp is described as the retention of placental remains after an obstetric procedure. The diagnosis is usually based on the first line with an ultrasound. The best therapeutic option is the evacuation of remains with a resectoscope under direct vision. Objective: To support the medical literature, describe clinical evolution, diagnostic methods and therapeutics. Clinical case: Female G1 P1 of 34 years, with intermittent transvaginal bleeding, 26 days after delivery, an exophytic tumor with necrotic surface and easy bleeding in the cervical canal was found. The β-hCG fraction was found in 10.5 µIU. Transvaginal sonography showed a rounded echogenic area on Doppler with increased vascularity. The persistence of transvaginal bleeding forced a hysterectomy. The histopathological study reported a polypoid lesion occupying the cervical os, microscopy showed phantom villi, corresponding to placental polyp. Conclusions: The placental polyp is a rare entity, which can cause late hemorrhage. A thorough questioning and physical examination is required. Ultrasonographic examination and histopathological study should be performed to reach the diagnosis. The treatment is focused on hysteroscopy management.

REFERENCES

1. Benites VE. Retención placentaria como causa de hemorragia postparto en el hospital de vitarte- caso clínico 2015. [Tesis de Grado] Facultad de Ciencias Humanas y Ciencias de la Salud. Ica, 2016.

2. García-Lavandeira S, Alvarez-Silvares E, Rubio-Cid P, Borrajo-Hernández E. Hemorragia posparto Secundaria o tardía. Ginecol Obstet Mex. 2017; 85 (4): 254-266.

3. Advanced Life Support in Obstetrics (ALSO). Provider manual 2017.

4. Shanthi V, Rao NM, Lava nya G, Krishna BA, Mohan KV. Placental polyp - a rare case report. Turk Pathology Derg. 2015; 31 (1): 77-79.

5. Behnamfar, Fariba et al. A case of placental polyp after normal vaginal delivery. J Res Med Sci. 2014; 19 (7): 680-682.

6. Geburtshilfe Z. El pólipo placentario, causa de hemorragia puerperal tardía. Perinatol. 1982; 186 (1): 15-18.

7. Tomoko Ishihara, Haruhiko Kanasaki, Aki Oride, Tomomi Hara, Satoru Kyo Differential diagnosis and management of placental polyp and uterine arteriovenous malformation: case reports and review of the literature. Womens Health. 2016; 12 (6): 538-543.

8. Consenso FASGO “Enfermedad Trofoblástica Gestacional” coordinador: Dr. Martín Riegé (AAGO).

9. Pacheco LA, Olmedo MR, Larracoechea BJ, González de Gor Crooke R. Histeroscopia en el tratamiento de los pólipos placentarios. Prog Obstet Ginecol. 2013; 56 (3): 164-168.

10. Geburtshilfe. El pólipo placentario, causa de hemorragia puerperal tardía. Perinatol. 1982 Feb; 186 (1): 15-18.

11. Dwayne LW, Qureshi F. “Placental polyp”: light microscopic and immunohistochemical observations. Hum Pathol. 1988; 19 (12): 1467-17470.

12. Hatada Y. An unexpected case of placental polyp with villi devoid of cytotrophoblastic cells. J Obstet Gynaecol. 2004; 24 (2): 193-194.

13. Shanthi V, Rao NM, Lava nya G, Krishna BA, Mohan KV. Placental polyp - a rare case report. Turk Pathology Derg. 2015; 31 (1): 77-79.

14. Jiménez JS, Gonzalez C, Alvarez C, Muñoz L, Pérez C, Muñoz JL. Conservative management of retained trophoblastic tissue and placental polyp with diagnostic ambulatory hysteroscopy. Eur J Obstet Gynecol Reprod Biol. 2009; 145 (1): 89-92.

15. Mori M, Iwase A, Osuka S, Kondo M, Nakamura T, Nakahara T et al. Choosing the optimal therapeutic strategy for placental polyps using power Doppler colors coring: Transarterial embolization followed by hysteroscopic resection or expectant management? Taiwan J Obstet Gynecol. 2016; 55 (4): 534-538.