Diagnosis and Management of Hypervascular Placental Polypoid Masses (Placental-Polyps): A Report of 4 Cases
Katrina Fidelina C. Adan, MD; Lara Marie D. Bustamante, MD, FPOGS, FPSUOG
Section of Ultrasound, Department of Obstetrics & Gynecology, Philippine General Hospital
A placental polyp is a polypoid or pedunculated mass or fragment of placental tissue retained in the uterine cavity for an indefinite period of time after abortion or partuition. These retained fragments of placental tissues, especially the hypervascular types, are common causes of vaginal bleeding in the puerperium, or occasionally, months or years after abortion or partuition, and may cause profuse hemorrhage. It is rare with an incidence of < 0.25% of all pregnancies. Despite its rarity, it is potentially life threatening, and high clinical suspicion and prompt and early diagnosis is essential, as well as an accurate diagnosis of neovascularisation to prevent hemorrhagic complications. We present four cases of hypervascular placental polypoid masses wherein thorough history taking and physical examination, in conjunction with serum ?-HCG levels and transvaginal ultrasonography with Color Doppler findings led to the prompt diagnosis of this clinical entity. Pelvic ultrasound with Doppler imaging is the most useful initial test for a suspected hypervascular lesion, because it distinguishes tissue with abundant vascularity from that with little or no blood supply. Other useful diagnostic procedures include Magnetic Resonance Imaging (MRI) and Computed Tomography (CT) angiography. Successful conservative management of placental polypoid masses by methotrexate administration, hysteroscopic resection, and uterine artery embolization (UAE) have been reported. Hysterectomy is reserved for patients with intractable vaginal bleeding and patients who are no longer desirous of future pregnancies. Hysteroscopic resection was successfully done in two cases presented, while the other two patients underwent hysterectomy.