Do Uterine Leiomyomas Influence Pregnancy Outcome?

Abstract

To evaluate the clinical significance of the presence, location, size, and number of uterine leiomyomas in pregnancy, a retrospective cohort study in which pregnancy complications and outcome of pregnant women with uterine myomas was undertaken by routine second trimester ultrasound examination. The case group consisted of 183 consecutive women with uterine myomas detected and followed during the years 1983-1989; the control group was made up of all pregnancies diagnosed and followed at the obstetric clinic during the period 1985-1987. The incidences of preterm delivery (less than 37 weeks), preterm premature rupture of membranes, in utero growth retardation (less than 5th percentile), placental abruptio, placenta previa, postpartum hemorrhage (more than 500 cc), and retained placenta were not significantly increased in the group of women with myomas compared with the general population. However, cesarean sections were more common in women with myomas (23 vs 12%; P < 0.001). Within the group of women with myomas, the incidence of cesarean section was not different in cases with multiple rather than solitary myomas, but it was significantly higher in cases of lower uterine segment compared with fundal myomas (39 vs 18%; P < 0.01) and when the mean diameter of the myoma was greater than 5 cm (35 vs 17%; P = 0.01). Stepwise logistic regression analysis showed that both myoma location and size were independent predictors of the odds of cesarean section.

The impact of fibroid characteristics on pregnancy outcome

“…Caesarean section was significantly more likely if the fibroids were in the lower part of the uterus, which is consistent with findings by Lev-Toaff et al 11 and Vergani et al 14 . However, our findings did not show a relationship between mode of delivery and the number of fibroids, which conflicts with previously reported findings 7,11 .…”

“…However, our findings did not show a relationship between mode of delivery and the number of fibroids, which conflicts with previously reported findings 7,11 . Although some studies 12,14 suggested that larger fibroids were more likely to be associated with operative delivery, we could not demonstrate a similar association. In fact, our data support the conclusions of a study by Roberts et al 15 where multiple or larger fibroids were not associated with increased risk of caesarean section.…”

Myomectomy during Caesarean Section is Likely Feasible

“…The association between fibroids and placenta previa has been examined, which suggested that the fibroids made risk of placenta previa in future pregnancy increased with a 2-fold [10,20,23]. Reports on the relationship between fibroids and postpartum hemorrhage are conflicting [20,24,25], pooled cumulative data suggested that postpartum hemorrhage with 2.5% was significantly more likely in women with moymas compared with control subjects with1.4%, because fibroids may distort the uterine architecture and interfere with myometrial contractions result in uterine atony and postpartum hemorrhage.…”

Uterine Atony: Management Strategies

“…However, the existing data are conflicting with regards to relationship between uterine fibroids and uterine atony (Hasan et al, 1991;Qidwai et al, 2006;Roberts et al, 1999;Vergani et al, 1994). Patients with connective tissue disorders are at a higher risk of PPH as compared to the general population (Kominiarek & Kilpatrick, 2007) which is explained by poor connective tissue support.…”