Objective <p>This study aims to explore the clinical efficacy and safety of hysteroscopic decidua polypectomy during pregnancy.</p> Methods <p>This retrospective study analyzed 38 patients presenting with recurrent vaginal bleeding due to pregnancy-associated decidual polyps who underwent hysteroscopic polypectomy at the Obstetrics and Gynecology Hospital of Fudan University from January 2023 to January 2025. Data on surgical techniques, timing of intervention, and subsequent pregnancy outcomes were evaluated.</p> Results <p>A total of 38 patients who underwent hysteroscopic decidual polypectomy were included in this study, with an age range of 23-39 years (mean 28.7 ± 2.4 years). Among them, 31 were primiparous and 7 were multiparous. The gestational age at surgery ranged from 8 to 19 weeks (mean 11.0 ± 3.2 weeks). All 38 patients presented with recurrent vaginal bleeding during pregnancy. The polyp diameter ranged from 1.4 to 5.5 cm (mean 3.82 ± 1.50 cm), with 22 cases (57.9%) having a diameter greater than 3 cm. All 38 patients successfully underwent hysteroscopic resection. The operative time ranged from 4 to 10 minutes (mean 5.43 ± 1.42 minutes), , with intraoperative blood loss of 0–5 ml (mean 2.53 ± 0.49 ml). No patient experienced postoperative rebleeding or any perioperative complications. Of the 38 patients, 37completed pregnancy; the full-term delivery rate was 94.6% (35/378), with gestational age at delivery of 37–41.4 weeks (mean 39.12 ± 1.02 weeks). Among these, 26 spontaneous vaginal deliveries, 8 cesarean sections, and 1 forceps delivery. The preterm birth rate was 5.3% (2/38), and the spontaneous abortion rate was 2.6% (1/38).</p> Conclusion <p>Hysteroscopy allows for painless, rapid , and precise resection of decidual polyps with effective hemostasis. It represents a safe and effective surgical approach for treating decidual polyps during pregnancy, but should be performed by experienced hysteroscopists to ensure optimal outcomes.</p>