Adverse obstetric outcomes in pregnant women with uterine fibroids in China: A multicenter survey involving 112,403 deliveries

Abstract

ObjectiveTo estimate the association between uterine fibroids and adverse obstetric outcomes.MethodsThis was a retrospective cross-sectional study of 112,403 deliveries from 14 provinces and 39 different hospitals in 2011 in mainland China. We compared pregnancy outcomes in women with and without uterine fibroids who underwent detailed second trimester obstetric ultrasonography during 18 to 22 weeks. Obstetric outcomes include cesarean delivery, breech presentation, preterm delivery, placenta previa, placental abruption, premature rupture of membranes and neonatal birthweight. Univariate analyses and multivariate logistic regression analyses were performed.ResultsOf 112,403 women who underwent routine obstetric survey, 3,012 (2.68%) women were identified with at least 1 fibroid. By univariate and multivariate analyses, the presence of uterine fibroids was significantly associated with cesarean delivery (Adjusted odds radio [AOR] 1.8, 95% confidence interval [CI] 1.7–2.0), breech presentation (AOR 1.3, 95% CI 1.2–1.5) and postpartum hemorrhage (AOR 1.2, 95% CI 1.1–1.4). The size of uterine fibroids and location in uterus had important effect on the mode of delivery. The rates of PPH were significantly higher with increasing size of the uterine fibroid (P<0.001). And the location of fibroid (intramural, submucosal or subserosal) also have a statistically significant impact on the risk of PPH (5.6% [subserosal] vs 4.7% [submucosal] vs 8.6% [intramural]).ConclusionPregnant women with uterine fibroids are at increased risk for cesarean delivery, breech presentation and postpartum hemorrhage. And different characteristics of uterine fibroids affect obstetric outcomes through different ways. Such detailed information may be useful in risk-stratifying pregnant women with fibroids.

Uterine fibroids and preterm birth risk: A systematic review and meta‐analysis

“…Finally, 19 articles (18 studies) were included in this meta-analysis. [24][25][26][27][28][29][30][31][32][33][34][35][36][37][38][39][40][41][42] One of these papers reported complementary information to the primary outcome information. 35,38 The selection process is shown in Figure 1.…”

“…26,33,35,38,41 There were also 13 case-control studies, including 10 270 pregnant women with UF and 150 795 control women without UF. 24,25,[27][28][29][30][31][32][34][35][36][37]40,42 In all included studies, the presence or absence of UF was determined by ultrasound examination during the first or second trimesters of gestation. Characteristics of the included studies and participants are displayed in Table 1.…”

“…Characteristics of the included studies and participants are displayed in Table 1. Five populations were studied in the United States, 26,29,30,35,39 seven in Europe, 24,25,28,[32][33][34]41 three in Asia, 27,36,42 two in Africa 31,40 and one in Mexico. 37 Two articles reported different results of the same cohort.…”

“…Eighteen studies reported an increased risk of preterm birth <37 weeks of gestation in women with UF (RR = 1.43, 95% CI 1.27-1.60, P < 0.001; I 2 = 60%; Figure 2a). [24][25][26][27][28][29][30][31][32][33][34][35][36][37][38][39][40][41][42] In 10 studies, pregnant women with UF were older than those without fibroids (MD = 2.40 years, 95% CI 0.94-3.85, P < 0.001). [24][25][26][30][31][32][33]37,39,40 Six studies also showed the association of UF with preterm birth <34 weeks (RR = 1.79, 95% CI 1.32-2.42, P < 0.001; I 2 = 68%; Figure 2b).…”

Diagnostic ambiguity of a uterine fibroid with abnormal appearance after severe red degeneration: A case report

“…Zhao et al reported that 2.68% of Chinese pregnant women were identified with at least one fibroid. Red degeneration of uterine fibroids is most frequent around the 20th week of gestation and during puerperium.…”