* Ultrasound Division, ASL Roma B, Rome, Italy;
** Reparto di ostetricia e ginecologia, Ospedale Fatebenefratelli San Pietro Rome, Italy.
*** Ultrasound Division, Ceprano Hospital, Ceprano, Italy.
These are 2 cases of endometrial polyps in the first trimester of pregnancy associated with embryo demise.
This is the case of a 32 years old patient (G1P0). The patient was asymptomatic before pregnancy. She presented with vaginal bleeding after 6 weeks of amenorrhea and ultrasound showed a regular yolk sac and vital embryo inside the gestational sac. Furthermore, a hyperechoic mass of 24 x 14 mm originating from the anterior uterine wall was bulging into the gestational sac. Color and Power Doppler showed no vascularity. Endometrial polyp was suspected. The patient stopped bleeding and she came back for her first trimester screening at 13 weeks when demised embryo was found. The embryo measured 23 mm corresponding to 9th week of pregnancy.
Uterine cavity revision and curettage were performed and the patient was scanned transvaginally after her first period. A suspicion of an endometrial polyp was raised. The polyp was smaller than in pregnancy probably due to less hormonal stimuli out of the pregnancy and/or for possible its partial removal during uterine cavity revision. The polyp was removed by hysteroscopy and following histology confirmed the diagnosis.
Images 1, 2, 3, 4: Image 1 shows demised embryo within gestational sac. Images 2, 3, 4 show endometrial polyp bulging into the gestational sac.
This is the case of a 33 years old patient G2P2 with non contributive history. She stated no spotting and no hypermenorrhea before the actual pregnancy. The patient was bleeding at the time of her first examination performed at 8 weeks of amenorrhea. An embryo of 4 mm with no heartbeat was visualized and a hyperechoic mass of 28 mm was seen inside the uterine cavity. It presented no vascularity at color and power Doppler except of a vascular pedicle arising from the uterine wall towards the mass. A subsequent control was performed one week later and found demised embryo. Ultrasound after first menstrual bleeding following curettage showed the endometrial polyp.
Images 5, 6, 7, 8: Images show endometrial polyp within the uterine cavity with its vascular pedicle visible on color Doppler scans (images 6, 7, 8).