Decidual Cast

The decidual cast begins to develop as the uterus is being prepared for the implantation process, with the shedding off and is taking the similar shape of the uterus itself. These formed casts are noted to have the capacity to continue to grow even without any pregnancy that takes place successfully.

Decidual uterine cast

What are the causes of Decidual Cast?

Decidual casts can be formed due to the following causes:

Use of Contraceptives

The use of combined oral contraceptive pills may lead to the occurrence of decidual casts.

There have been cases of dysfunctional uterine bleeding where the patient was prescribed of a monophasic oral contraceptive and a large decidual cast was discovered during the treatment regimen. The same will occur in cases of treating oral pills for an adolescent menorrhagia. Depot medroxyprogesterone acetate (DMPA) is an injectable form of contraceptive which has been proven to cause for the formation and delivery of decidual casts too.

Endometriosis problem

Endometriosis is a reproductive health problem which involves the visibility of an endometrial tissue outside the uterine cavity, causing pelvic pain to be felt by the patient and some chances of infertility. It has been found out that the progesterone treatment utilized for endometriosis leads to decidual cast.

Pregnancy state of  a woman

A state of pregnancy may possibly cause lesions in the uterine wall, which might be a resulting effect of having cervical cancer. Decidual casts have very little percentage to be induced by pregnancy, although in some cases it has something to do with cervical cancer and placenta previa cases as well, where there is an earlier expulsion of the placenta that can happen.

Ectopic or tubal pregnancies

An ectopic pregnancy is a type of the pregnancy where the fertilized egg is being implanted outside the uterus, mostly in the fallopian tubes, thus it’s being called as tubal pregnancy. Ectopic pregnancies are closely associated with the development of decidual casts.

One of its manifestation which is the vaginal bleeding or the brownish-colored discharges is often the result during the shedding off of decidual casts when positive pregnancy fails among women. The presence of decidual cysts is considered precursors of decidual casts. Assessment finding of decidual cysts can indicate the existence of an ectopic pregnancy.

• As a side effect for women who are taking the human menopausal gonadotropin (HMG), human chorionic gonadotropin (HCG) and progestogens.

Signs and Symptoms of Decidual Cast

Common signs

• Severe abdominal pain
• Painful vaginal bleeding

Rare signs

• Passage of decidual cast, fleshy tissue after a few months of taking oral contraceptive pills to promote regular menstrual cycle or to resolve problems of hormonal imbalances among women
• Membranous dysmenorrhea with passage of an intact endometrial cast through an n0ndilated cervix of a woman

Diagnostic Examinations

The diagnosis made is usually based upon a thorough history taking, manifestations of the different clinical symptoms, physical examination done, the performance of histopathology and the transvaginal ultrasonography with laparoscopy.

• Histopathology is pertaining to a histopathological examination done to the patient for the purpose of confirming the diagnosis of decidual cast. The result will indicate some changes in the endometrium.

• Vaginal ultrasonography is done to visualize the problem that affects the cervix reaching to the uterine cavity of a woman.

Management and Treatment

Medications

• Pain reliever such as the nonsteroidal anti-inflammatory medications may be given (NSAIDs) as necessary for symptomatic pain relief only.
• Pills to control the bleeding or stop the menstrual cycle for long to allow time for the uterus to rest. Yasmin is an example to alleviate heavy painful periods.
• It is prescribed for three consecutive months before a menstrual period can follow. Other over the counter pills may also help. Seasonale can be taken and will give the patient to have menses for only four times in a year. Anya is a new pill which is deemed to stop periods on a permanent basis.
• Vasopressin injection may be used to control the bleeding. Others may take tranexamic acid orally depending on the situation.
• IM injection of Methotrexate

Methotrexate acts by inhibiting the division and growth of placental cells, thereby affecting the embryo in the blood stream by making it reabsorbed into the body.

Blood testing for the presence of an HCG level is highly recommended by attending physicians to patients to make sure and to countercheck that the pregnancy has been terminated.  The patient has to be informed that a treatment effect by methotrexate is an increased abdominal pain, increased levels of HCG in the first 1-3 days of administration of the drug and some vaginal bleeding or spotting tendencies. This is to allay the feelings of fear and decrease the levels of anxiety during the treatment.

Procedures

• Blood transfusion can be done for severe bleeding when the patient is confined in the hospital and vital signs have to be closely monitored.

• Laparoscopic removal of an ectopic pregnancy either through a salpingectomy or salpingotomy. Laparoscopy is a surgical procedure that involves the incision of tiny cuts made by physicians into the abdomen of a patient to visualize the status of internal organs, with the objective to repair or to remove a dysfunctional tissue. It is often used to validate problems such as the presence of cysts, fibroids, adhesions and some infection in the affected site.
• Surgical Laparotomy to remove an ectopic pregnancy refers to a large surgical incision done on the abdomen to gain full and easy access into the abdominal cavity and to check for diseased organs inside that has to be removed.

References:

1. http://ispub.com/IJGO/9/1/11420
2. http://www.ehow.com/info_8441129_causes-decidual-cast.html
3. http://connection.ebscohost.com/c/articles/28459035/decidual-cast
4. Cunningham, F. Gary, ed. (2005). Williams obstetrics (22nd ed.). New York ; Toronto: McGraw-Hill Professional. ISBN 9780071413152.
5. Wu, DC.; Hirschowitz, S.; Natarajan, S. (May 2005). “Ectopic decidua of pelvic lymph nodes: a potential diagnostic pitfall”. Arch Pathol Lab Med 129 (5): e117–20.
6. Edmondson, N.; Bocking, A.; Machin, G.; Rizek, R.; Watson, C.; Keating, S. (2009). “The prevalence of chronic deciduitis in cases of preterm labor without clinical chorioamnionitis”. Pediatr Dev Pathol 12 (1): 16–21.