Fibroids and reproductive outcomes: a systematic literature review from conception to delivery

Klatsky, Peter C.; Tran, Nam; Caughey, Aaron B.; Fujimoto, Victor Y.

doi:10.1016/j.ajog.2007.12.039

Cited by 494 publications

(451 citation statements)

References 41 publications

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“…The overall rate of preterm delivery in this study was 13% (18/136), and the rate of caesarean section was 51% (69/136) which is consistent with previously published data 13 . However, there was a high rate of postpartum haemorrhage in our cohort (14%, 19/136), compared to 2.5% as suggested in the systematic review by Klatsky et al 13 .…”

Section: A C C E P T E D Accepted Manuscriptsupporting

confidence: 81%

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The impact of fibroid characteristics on pregnancy outcome

Lam

Best

Kumar

2014

American Journal of Obstetrics and Gynecology

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Objective: To assess the influence of different characteristics of fibroids on pregnancy outcome.Study design: We identified women with fibroids ≥4 cm in size on ultrasonography at the dating scan between January 2002 and December 2012. The size (4-7cm, 7-10cm, >10cm), number (multiple/single), location (lower uterus/body of uterus) and type (intramural, combination of intramural/subserosal, subserosal) were ascertained. Medical records were reviewed to obtain pregnancy outcomes (preterm delivery, birth weight, mode of delivery, estimated blood loss, postpartum haemorrhage and admission for fibroid related pain).Results: 121 patients with 179 pregnancies were identified. Preterm delivery was more likely in those with multiple fibroids compared to single fibroids (18% v 6% p=0.05). The location of fibroid had an important effect on mode of delivery with a higher caesarean section rate for fibroids in the lower part of uterus than in the body of the uterus (86% v 40% p=0.01), a higher rate of postpartum haemorrhage (22% v 11%p=0.03) and greater estimated blood loss This information can be used to aid counselling women antenatally and in risk stratifying patients.

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Section: A C C E P T E D Accepted Manuscriptsupporting

confidence: 81%

“…Some studies suggest that there is an increase in the rates of miscarriage, preterm labour/delivery and haemorrhage 13 . What is even less well described in the literature is the effect of size, number, location and type of fibroid (i.e.…”

Section: Introductionmentioning

confidence: 99%

The impact of fibroid characteristics on pregnancy outcome

Lam

Best

Kumar

2014

American Journal of Obstetrics and Gynecology

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“…Some authors supported that the specific operative techniques such as tourniquet, uterine artery ligation, and pursestring suture are helpful to limit intraoperative bleeding during caesarean myomectomy [4,5]. Though, we did not use aforementioned techniques in present case, diluted vasopressin injection, correct surgical plane of dissection, double layered sutures, intraopeartive and postoperative uterotonic agents were effective in haemostasis.…”

Section: Discussionmentioning

confidence: 82%

Caesarean Myomectomy in a Cervical Fibroid: A Brief Communication

Tm¹,

Gp²,

Soman³

et al. 2017

IPCB

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Submit Manuscript | http://medcraveonline.com Compared to uterine corpus, cervical myomas pose a challenge due to its close relation with other organs like bladder, ureter and rectum. The surgical approach needs to be modified in each case. Surgical difficulties associated with these cases are poor access to myoma, difficulty in suturing and repairs, increased blood loss and distortion of the vital neighbouring structures in the pelvic cavity, making it vulnerable to injuries. The pregnancy poses a unique challenge of pregnancy related changes in fibroids and increased vascularity of the organ, making caesarean myomectomy a complicated procedure. Case ReportCervical fibroids, both in pregnant and non pregnant status are a clinically challenging situation for surgeons. We are discussing a case of 32 year female with term pregnancy incidentally detected to have a sessile cervical fibroid during her antenatal scans which had remained of the same size (6.5 x5cm) (Figure 1) throughout her pregnancy as usually happens in 70-80% of cases. The lady was asymptomatic. On examination a bulge was seen in the anterior upper vagina, pushing the cervix posteriorly. The term ultrasound showed 6x5cm fibroid in the supravaginal portion of the cervix (intracervical type) just below internal os. Since she had a history of a previous caesarean section with cervical fibroid, she was posted for elective caesarean at 39 completed wks. The questions to be answered at this point are 1. Whether to do a concurrent caesarean myomectomy? 2. Whether to proceed vaginally or abdominally? 3. Will a tourniquet help in reducing the blood supply to cervical myoma, if so at what level?Review of literature at this point said myomectomy during caesarean section could be generally recommended. The decision should be carefully taken in presence of surgical expertise and tertiary level care facilities. Depending on size and location of myomas, the associated risks are similar to those of isolated caesarean section [3]. Since lower uterine segment was free of a fibroid, she was delivered by a lower uterine segment transverse incision. After caesarean, an attempt was made for cervical examination through the hysterectomy wound, a 6.5 x5cm sessile fibroid occupying whole of the anterior lip of cervix was felt. The challenge here was, fibroid couldn't be reached easily or seen through the incision. The question, whether a vaginal examination will help in myomectomy? Was kept in mind. The diluted vasopressin injection was injected into the uterus. Bladder was dissected from vesicovaginal fascia (Figure 2) using mayo's scissors till the lower end of the cervix. Then the cervix was hooked up using left finger inside the cervical canal keeping in mind the location of the fibroid and its relation to the bladder and vagina, pushing the bladder safely down. A transverse incision was made in the anterior vaginal wall and then cervicotomy was done to reach the myoma. The myoma was enucleated (Figure 3) which weighed 100gms. Myoma bed was sutured in 2 layers (Figure 4...

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“…Literature suggest there is doubtful evidence of performing myomectomy in asymptomatic patients. 19,20 It can be performed laparoscopically or hysteroscopically depending on the location of fibroid. Though uterine septum mostly associated with the recurrent abortion and not with infertility we report an incidence of 42 (12.61%) patients with infertility.…”

Section: Discussionmentioning

confidence: 99%

Role of hysterolaparoscopy for the evaluation of primary infertility: An experience from a tertiary care hospital

Pande

Dora

Pradhan

et al. 2017

Int J Reprod Contracept Obstet Gynecol

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INTRODUCTIONInfertility is one of the most common problem for which couple seeks medical attention. It is seen almost in 10-15% of the reproductive couple.1 Though there are various tests available for the evaluation of the patients with infertility, for the complete evaluation of pelvic pathology hysterolaparoscopy became the gold standard over the years. Ovulatory dysfunction accounts for 21% to 32%, tubal factor 14% to 26%, unexplained 8% to 30% and endometriosis accounts 4% to 6% of female infertility.2-4 Hysterolaparoscopy gives detailed and magnified view of uterine, adenexal, peritoneal and other intra-abdominal pathology. Consequently, milder degree of distal fimbrial pathology, endometriosis, and pelvic adhesions can be diagnosed and treated at the same time which was missed during a routine trans vaginal ultrasonography. The main objective of the study was to assess the role of diagnostic hysterolaparoscopy in the diagnosis and treatment of primary infertility patients. METHODSThis was a hospital based retrospective observational study. Medical records of all cases of primary infertility were retrieved and analyzed. This study was conducted ABSTRACT Background: Infertility is one of the most common problem for which couple seeks medical attention. The main objective of the study was to assess the role of diagnostic hysterolaparoscopy in the diagnosis and treatment of primary infertility patients. Methods: For this retrospective study, patient with the diagnosis of primary infertility were recruited. Patients admitted between the periods 2014 to 2016 were included. Pertinent data related to infertility were collected from the case records and entered in predesigned performa. Results: Patients with primary infertility 246 (82%) diagnosed to have pelvic pathology. The most common cause of infertility was ovarian 122 (36.63%), Uterine 66 (19.82%), tubal 84 (25.22%) and unexplained infertility in 103 (30.93%) women. Patients with PCOS 76 (22.82%) and endometriosis 46 (13.81%) treated with drilling and endometriotic cystectomy. In 32 (9.60%) of patients hysteroscopic cannulation was done. For distal tubal blockage fimbrioplasty was performed in 38 (11.41%) of women. Pelvic adhesions diagnosed in 26 (7.80%) women. patients diagnosed with uterine septum 42 (12.61%) required hysteroscopic septal resection. During the evaluation of infertility 70 (21%) of women diagnosed to have incidental pelvic pathology treated according to pathology. Conclusions: Hysterolaparoscopy is emerging as a valuable technique for complete assessment of female infertility and also helps in treatment according to the cause.

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Fibroids and reproductive outcomes: a systematic literature review from conception to delivery

Cited by 494 publications

References 41 publications

The impact of fibroid characteristics on pregnancy outcome

The impact of fibroid characteristics on pregnancy outcome

Caesarean Myomectomy in a Cervical Fibroid: A Brief Communication

Role of hysterolaparoscopy for the evaluation of primary infertility: An experience from a tertiary care hospital

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