Pregnancy outcomes in pregnant women with cervical polypectomy during pregnancy and analysis of influencing factors of pregnancy outcome in pregnant women with cervical polyps

doi:10.3877/cma.j.issn.1673-5250.2025.02.007

Objective

To explore the influence of cervical polypectomy during pregnancy on the pregnancy outcome of pregnant women，and the influencing factors of pregnancy outcome of pregnant women with cervical polyps.

Methods

A total of 97 pregnant women with cervical polyps who underwent regular prenatal examination in Beijing Anzhen Hospital affiliated to Capital Medical University from January 2019 to December 2022 were selected as the study objects.The clinical data were analyzed retrospectively.According to whether cervical polypectomy was performed during pregnancy or not，they were divided into operation group （n=25，accept cervical polypectomy）and non-operation group （n =72，not accept cervical polypectomy）.Independent-samples t test，chi-square test and Mann-Whitney U test were used to compare the general clinical data and the clinical data related to pregnancy outcome between two groups.Multivariate logistic regression analysis was used to analyze the influencing factors on the pregnancy outcome of pregnant women with cervical polyps in two groups.This study was approved by the Ethics Committee of our hospital （Approval No.2024218x），and all pregnant women gave informed consent to diagnosis and treatment.

Results

①The rate of preoperative vaginal bleeding，the bleeding duration of vaginal bleeding and the longest diameter of cervical polyps in operation group were 76.0%，7.00 d （0.25，30.00 d）and 2.5 cm（1.9，3.0 cm），respectively，which were higher，longer and larger than those of 26.4%，0 d（0，0.50 d）and 1.0 cm（0.5，1.4 cm）in non-operation group，and the differences were statistically significant （χ²=19.17，P＜0.001；Z=-5.15，P＜0.001；Z=-4.58，P＜0.001）.②There were no significant differences in spontaneous abortion rate，preterm birth rate，full-term birth rate，cesarean section rate，preterm membranes premature rupture rate and neonatal birth weight between 2 groups （P＞0.05）.③There were no significant differences in the incidence of postoperative vaginal bleeding，spontaneous abortion，premature delivery，full-term delivery and premature rupture of membranes between cervical polyps and cervical decidual polyps pregnant women in operation group（P＞0.05）.④Vaginal bleeding of pregnant women with cervical polyps （OR=9.836，95% CI：1.948-49.659，P=0.006）was an independent risk factor for full-term pregnancy in non-operation group.No independent influencing factors were found for pregnancy outcomes in operation group.

Conclusions

Cervical polypectomy during pregnancy does not increase the risk of miscarriage and premature delivery in pregnant women with cervical polyps.For those with vaginal bleeding symptoms and cervical polyps enucleation were not performed during pregnancy，may affect their full-term pregnancy.

Key words: Polyps, Cervical polypectomy, Pregnancy complications, Abortion,spontaneous, Pregnancy outcome, Root cause analysis, Pregnant women

表1 2组妊娠合并宫颈息肉孕妇一般临床资料比较

组别	例数	年龄（岁， $\overset{ˉ}{x}$ ± s ）	阴道流血症状［例数（%）］	阴道流血者流血时长［d，M ( Q₁,　 Q₃ )］	宫颈息肉直径［cm，M ( Q₁,　 Q₃ )］	阴道分泌物清洁度异常［例数（%）］	GBS阳性［例数（%）］
手术组	25	32.0±3.6	19（76.0）	7.00（0.25，30.00）	2.5（1.9，3.0）	2（8.0）	0（0）
未手术组	72	32.5±4.0	19（26.4）	0（0，0.50）	1.0（0.5，1.4）	9（1.3）	5（6.9）
统计量		t=0.68	χ ²=19.17	Z=-5.15	Z=-4.58	χ ²=0.37	χ ²=1.83
P值		0.413	＜0.001	＜0.001	＜0.001	0.723	0.323

表1 2组妊娠合并宫颈息肉孕妇一般临床资料比较

组别	例数	年龄（岁， $\overset{ˉ}{x}$ ± s ）	阴道流血症状［例数（%）］	阴道流血者流血时长［d，M ( Q₁,　 Q₃ )］	宫颈息肉直径［cm，M ( Q₁,　 Q₃ )］	阴道分泌物清洁度异常［例数（%）］	GBS阳性［例数（%）］
手术组	25	32.0±3.6	19（76.0）	7.00（0.25，30.00）	2.5（1.9，3.0）	2（8.0）	0（0）
未手术组	72	32.5±4.0	19（26.4）	0（0，0.50）	1.0（0.5，1.4）	9（1.3）	5（6.9）
统计量		t=0.68	χ ²=19.17	Z=-5.15	Z=-4.58	χ ²=0.37	χ ²=1.83
P值		0.413	＜0.001	＜0.001	＜0.001	0.723	0.323

表2 2组妊娠合并宫颈息肉孕妇妊娠结局相关临床资料比较

组别	例数	自然流产［例数（%）］	早产［例数（%）］	足月产［例数（%）］	剖宫产［例数（%）］	未足月胎膜早破［例数（%）］	新生儿出生体重（g， $\overset{ˉ}{x}$ ± s ）
手术组	25	1（8.0）	3（12.0）	21（84.0）	9（36.0）	3（12.0）	3 077±505
未手术组	72	1（1.4）	9（12.5）	62（86.1）	40（55.6）	3（42.9）	3 171±706
统计量		χ ²=0.63	χ ²＜0.01	χ ²=0.07	χ ²=2.55	χ ²=2.08	t=1.26
P值		0.451	＞0.999	0.751	0.156	0.167	0.265

表2 2组妊娠合并宫颈息肉孕妇妊娠结局相关临床资料比较

组别	例数	自然流产［例数（%）］	早产［例数（%）］	足月产［例数（%）］	剖宫产［例数（%）］	未足月胎膜早破［例数（%）］	新生儿出生体重（g， $\overset{ˉ}{x}$ ± s ）
手术组	25	1（8.0）	3（12.0）	21（84.0）	9（36.0）	3（12.0）	3 077±505
未手术组	72	1（1.4）	9（12.5）	62（86.1）	40（55.6）	3（42.9）	3 171±706
统计量		χ ²=0.63	χ ²＜0.01	χ ²=0.07	χ ²=2.55	χ ²=2.08	t=1.26
P值		0.451	＞0.999	0.751	0.156	0.167	0.265

表3 手术组2种病理学类型宫颈息肉摘除术后孕妇并发症及妊娠结局比较［例数（%）］

病理学类型	例数	术后阴道流血	自然流产	早产	足月产	未足月胎膜早破
宫颈息肉	21	3（4.8）	1（4.8）	3（14.3）	17（81.0）	3（14.3）
宫颈蜕膜息肉	4	1（25.0）	0（0）	0（0）	4（100.0）	0（0）
χ ²值		0.29	0.20	0.69	0.91	0.69
P值		0.527	0.655	0.406	0.340	0.406

表3 手术组2种病理学类型宫颈息肉摘除术后孕妇并发症及妊娠结局比较［例数（%）］

病理学类型	例数	术后阴道流血	自然流产	早产	足月产	未足月胎膜早破
宫颈息肉	21	3（4.8）	1（4.8）	3（14.3）	17（81.0）	3（14.3）
宫颈蜕膜息肉	4	1（25.0）	0（0）	0（0）	4（100.0）	0（0）
χ ²值		0.29	0.20	0.69	0.91	0.69
P值		0.527	0.655	0.406	0.340	0.406

表4 影响手术组妊娠合并宫颈息肉孕妇妊娠结局的多因素非条件logistic回归分析

影响因素	B	SE	Wald 值	P值	OR 值	OR 值95%CI
手术时孕龄（连续变量）	-0.327	0.222	2.162	0.141	0.721	0.476～1.115
既往流产次数（连续变量）	-18.751	18 115.310	0	0.999	0	0
术前阴道流血（vs 无阴道流血）	20.198	15 691.634	0	0.999	5.913×10⁸	-∞～+∞
术前阴道炎（vs 无阴道炎）	-19.786	24 605.185	0	0.999	0	0
术后阴道流血（vs 无阴道流血）	2.099	2.638	0.633	0.426	8.159	0.046～1 434.763

表4 影响手术组妊娠合并宫颈息肉孕妇妊娠结局的多因素非条件logistic回归分析

影响因素	B	SE	Wald 值	P值	OR 值	OR 值95%CI
手术时孕龄（连续变量）	-0.327	0.222	2.162	0.141	0.721	0.476～1.115
既往流产次数（连续变量）	-18.751	18 115.310	0	0.999	0	0
术前阴道流血（vs 无阴道流血）	20.198	15 691.634	0	0.999	5.913×10⁸	-∞～+∞
术前阴道炎（vs 无阴道炎）	-19.786	24 605.185	0	0.999	0	0
术后阴道流血（vs 无阴道流血）	2.099	2.638	0.633	0.426	8.159	0.046～1 434.763

表5 影响未手术组妊娠合并宫颈息肉孕妇妊娠结局的多因素非条件logistic回归分析

影响因素	B	SE	Wald 值	P值	OR 值	OR 值95%CI
既往流产次数（连续变量）	0.589	0.836	0.497	0.481	1.802	0.350～9.269
阴道流血（vs 无阴道流血）	2.286	0.826	7.657	0.006	9.836	1.948～49.659
阴道炎（vs 无阴道炎）	1.337	0.847	2.491	0.115	3.809	0.724～20.044

表5 影响未手术组妊娠合并宫颈息肉孕妇妊娠结局的多因素非条件logistic回归分析

影响因素	B	SE	Wald 值	P值	OR 值	OR 值95%CI
既往流产次数（连续变量）	0.589	0.836	0.497	0.481	1.802	0.350～9.269
阴道流血（vs 无阴道流血）	2.286	0.826	7.657	0.006	9.836	1.948～49.659
阴道炎（vs 无阴道炎）	1.337	0.847	2.491	0.115	3.809	0.724～20.044

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