Management of uterine leiomyomas in pregnancy: review of literature

Abstract

The incidence of uterine myomas in pregnancy is estimated from 0.1 to 3.9 %. Although a lot of women with uterine fibroids bring the pregnancy without adverse events, data provided in the literature suggest that uterine fibromyomas are associated with several complications. The most important clinic question concerns the impact of myoma on pregnancy and, in some cases, the possibility of a surgical treatment that guarantees a good security for the pregnancy course and the conservation of reproductive capacity. Electronic search of Pubmed between 1993 and 2011, using specific keywords. Management of leiomyomas in pregnancy is conservative and limited, when it is necessary, to medical therapy. The main conditions that induce inevitably the surgical procedure are the torsion of pedunculated fibroid or rare cases of necrosis and resultant inflammatory peritoneal reaction. Laparoscopy technique has several advantages in comparison to previous techniques such as best postoperative course with reduction of pain, fast recovery, less hospitalization and, absence of large and unaesthetic scars. The importance of maternal and fetal welfare thus requires a careful evaluation of several factors that, varying from case to case, lead the authors to choose the most appropriate management.

What Is the Role of Barbed Suture in Laparoscopic Myomectomy? A Meta-Analysis and Pregnancy Outcome Evaluation

“…During pregnancy, the surgical treatment of myomas is performed in selected cases: torsion of pedunculated fibroid, necrosis of myoma with consequent peritoneal inflammation; in fact, the risk of myomectomy and surgical complications, also during caesarean section, overcome the benefits of conservative approach. Usually the treatment of fibroids in pregnant women, if it is necessary, is based on medical therapy [44]. However, myomectomy has a significant role in women desiring future pregnancy because the surgical removal of fibroids can increase the fertility rate, restore the uterine anatomical structure, reduce the local tissue inflammation reaction, and promote the adequate uterine blood provisions [45].…”

Safety of pregnancy in uterine fibroids

“…Another cause of necrosis is the large expansion of fibroid in size without a similar increase in blood flow, leading to a mismatch between the vascular demand of the tissue and the available blood supply. 9 Furthermore, severe localized pain also arises from torsion of pedunculated sub-serosal uterine fibroids or from impaction of uterine fibroids compromising adjacent blood vessels. 3 Therefore, pain is the most common presentation of large (>5 cm) or complicated uterine fibroids during pregnancy.…”

“…3 Therefore, pain is the most common presentation of large (>5 cm) or complicated uterine fibroids during pregnancy. 7,9 Other less common symptoms include pelvic pressure, vaginal bleeding, urinary frequency, and constipation. 7,10 The large-sized fibroids exert pressure effects on nearby organs as well.…”

“…The prostaglandin release resulting from tissue damage results in further increase in pain and uterine contractions. 7,9 Other mechanisms involved include mechanical effects of uterine fibroids on fetal sac. The size, site, number, type (subserosal, intramural, or submucosal), and shape (sessile or pedunculated) are responsible for various mechanisms of adverse effects.…”

Three dimensional ultrasound- its use in defining and prognosticating fibroid associated with pregnancy: one picture is worth more than a thousand words

“…1 Fibroids associated pregnancies are considered to be high-risk pregnancies due to the increase incidences of spontaneous miscarriages, preterm labor, placenta abruption, malpresentation, labor dystocia, cesarean delivery, and postpartum hemorrhage.…”