Placental polyp after normal vaginal delivery: a rare diagnostic dilemma

Placental polyp is retained placental tissue within the endometrial cavity, which forms a nidus for inflammation and bleeding. Placental polyp is a rare entity with an incidence of less than 0.25% of all pregnancies as reported. Here, we report a case of 23-year-old P2L2 woman with complaints of intermittent vaginal bleeding since her recent normal vaginal delivery, 1.5 months back. A polypoid mass (51×41 mm) with abundant vascularity was detected as retained products of placenta (RPOC) within the endometrial cavity by imaging studies. A combination of polypoidal mass within the endometrial cavity with normal beta human chorionic gonadotropin (hCG) of <2.0 mIU/ml raising the suspicion of retained products of placenta or trophoblastic neoplasms. After yielding an unsatisfactory biopsy containing only fibrin deposition, total hysterectomy was performed due to profuse bleeding during biopsy. The uterus specimen showed slight globular enlargement with presence of a red-coloured polypoid mass within the endometrial cavity with rough outer surface and fragile consistency. The histological specimen of the protruding lesion, from the exaggerated placental implantation site, showed intermediate trophoblastic cells infiltrated into the myometrium, which might lead to the diagnosis of placental polyp. However, since placental polyp and uterine arteriovenous malformation have similar clinical characteristics, it is important to accurately identify and differentiate between them to ensure optimal treatment therapy. Definite diagnosis is ultimately made by histopathological examination. We report here a case that is suggestive of either a placental polyp or uterine arteriovenous malformation and will discuss the differential diagnoses and treatments for both diseases, based on a literature review.

A study of effect of intra umbilical oxytocin in active management of third stage of labour

Background: Postpartum haemorrhage is a single major and leading cause of maternal morbidity and mortality. PPH is the loss of more than 500 ml blood following vaginal delivery or 1000 ml blood following caesarean section. India has a maternal mortality ratio of 167 per 1 lakh live births. The most common cause of maternal mortality is haemorrhage which accounts for 25-30% of maternal mortality of which PPH is a significant cause.Methods: 200 patients were included in this prospective observational study and divided into two groups, group A, underwent only active management of third stage of labour and group B received intra umbilical oxytocin administration in addition to AMTSL. The maternal and neonatal outcome was observed between the two and the difference was noted.Results: Mean duration of third stage of labour of group A patients was 3.89±0.89 minutes and Mean blood loss was 386±85.30 ml and that of group B patients was 1.96±0.68 minutes and 235±72.99 ml respectively. These were found to be statistically significant among all the other parameters.Conclusions: The duration of third stage of labour and the amount of postpartum blood loss was significantly less when intra umbilical injection of oxytocin was used in addition to AMTSL. So, to conclude intra umbilical vein oxytocin injection should be used routinely in addition to AMTSL in order to prevent PPH.