Number and size of uterine fibroids and obstetric outcomes

Ciavattini, Andrea; Clemente, Nicolò; Carpini, Giovanni Delli; Giuseppe, Jacopo Di; Giannubilo, Stefano Raffaele; Tranquilli, Andrea Luigi

doi:10.3109/14767058.2014.921675

Cited by 109 publications

(98 citation statements)

References 20 publications

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“…Moreover, uterine fibroids seem to be related to infertility, early pregnancy loss, and several adverse obstetric outcomes. [2,3] The choice of the appropriate therapy for uterine fibroids is influenced by several factors, including the severity of symptoms, infertility, the tumor characteristics (number, size, and location), the patient's age, wish to preserve the uterus, and the desire of future pregnancies. [4] …”

Section: Introductionmentioning

confidence: 99%

Hypovitaminosis D and “small burden” uterine fibroids

et al. 2016

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The aim of this study was to evaluate the effect of vitamin D supplementation in women with hypovitaminosis D and “small burden” uterine fibroids.This study focused on 208 women diagnosed with uterine fibroids and concomitant hypovitaminosis D, from January to December 2014. One hundred eight women of the initial study population were diagnosed with “small burden” uterine fibroids. Among them, those who underwent a proper vitamin D supplementation constituted the “study group” (n = 53), while women who spontaneously refused the therapy or did not perform it properly, constituted the “control group” (n = 55). The characteristics of uterine fibroids, the fibroid-related symptoms, and the vitamin D serum levels were evaluated 12 months after the initial diagnosis.In women with uterine fibroids, a negative correlation emerged between the baseline 25-hydroxy-cholecalciferol (25-OH-D3) concentration and both the volume of the largest fibroid (r = −0.18, P = 0.01) and the total volume of fibroids (r = −0.19, P = 0.01). No correlation was found between the baseline 25-OH-D3 levels and the number of fibroids per patient (r = −0.10, P = 0.16). In women of the “study group,” a significant increase in the 25-OH-D3 serum level was observed after 12 months of supplementation, and a lower rate of surgical or medical treatment due to the “progression to extensive disease” was reported (13.2% vs 30.9%, P = 0.05).Supplementation therapy with 25-OH-D3 restores normal vitamin D serum levels in women with “small burden” fibroids. In these women, vitamin D supplementation seems to reduce the progression to an extensive disease, and thus the need of conventional surgical or medical therapy.

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Section: Introductionmentioning

confidence: 99%

Hypovitaminosis D and “small burden” uterine fibroids

et al. 2016

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“…Bleeding in first trimester is seen if the placenta implants close to the fibroid, and the incidence of preterm labour, if not preterm premature rupture of membranes, is also increased. Ciavattini et al [10] demonstrated that the risk of preterm labour is significantly increased with both multiple fibroids (29.4% vs 5% in women with no fibroids) as well as with large fibroids >5cm (16.4% vs 5%) [10]. Shavell [5] also demonstrated the earlier mean gestational age of delivery in pregnancies complicated by >5cm fibroids against subgroups of smaller fibroids (1-5cm) and no fibroids (36.5 vs 38.4 vs 36.5 weeks) [5].…”

Section: Discussionmentioning

confidence: 99%

“…Large, multiple fibroids as well as lower segment fibroids increase chances of malpresentations (OR:2.9) and hence caesarean sections (OR:3.7)(10). Multiple fibroids in pregnancy increase caesarean section (73.5% vs 37%, p<0.01) and breech presentation rates (11.8% vs 2.7%, p=0.04) [10]. Blood loss at delivery is increased more so for larger>5cm fibroids than smaller fibroids and normal pregnancy (645ml vs 535ml vs 486ml) [5].…”

Section: Discussionmentioning

confidence: 99%

Obstetric Outcomes with Large Fibroids in Pregnancies Nearing Term: A Study in a Tertiary Care Centre in Rural India

Dasgupta¹

2017

OGIJ

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Purpose: The exact incidence of large fibroids (>5cm) complicating pregnancy is not known and the numbers are increasing. There are not enough studies with large fibroids in pregnancy as most of them find it difficult to conceive. Methods:We present a prospective evaluation of a series of 15 patients with large fibroids (>5cm) complicating pregnancies, who had delivered in our hospital over a period of 6 months. They had often not been booked in pregnancy earlier.We considered only those with large fibroids in the lower uterine segment and reviewed the related adverse maternal and fetal outcomes at or near term and any complications at post natal follow-up.Results: All the women underwent caesarean deliveries. 8 of the 15 (53%) women were at 34 yrs of age and 13 out of the 15 (87%) women had a history of infertility. 7 out of 15 women delivered prematurely (46%). 2 women (13.33%) with the largest fibroids measuring up to 16 and 24 cm respectively needed prophylactic bilateral internal iliac artery ligation and myomectomy to deliver the baby but avoided caesarean hysterectomies. Myomectomy could be avoided in the remaining 13 women. 60% women had fetal malpresentations. 9 out of 15 women (60%) had postpartum hemorrhage and most of the women (87%) needed blood transfusions. Posteriorly located cervical fibroids bled more than anterior cervical fibroids. Puerperal pyrexia was noted in 50% of the women with retained uterus. Conclusion:Reduction of fibroid size pre-pregnancy could have avoided maternal and fetal complications which became inevitable once pregnancy reached advanced gestation. When women do present at term pregnancy with such large fibroids devascularisation techniques like prophylactic bilateral internal artery ligation may reduce blood loss and avoid caesarean hysterectomy.

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“…En nuestro estudio, los hallazgos ecográficos sospechosos fueron descritos de forma precoz, en el segundo trimestre de gestación: dos casos en la semana 16 otro en la semana 18 y otro en la 20. La implantación de la placenta sobre el mioma pudo ser factor decisivo (12) aunque no todos los autores encuentran asociación entre útero miomatoso y desprendimiento placentario (13). Concluimos que las imágenes de engrosamiento difuso placentario en ausencia de infección o aneuploidía, combinado con RCIU y oligoamnios podrían predecir la muerte perinatal.…”

Section: Discussionunclassified

Evolución y aspectos ecográficos del desprendimiento crónico de placenta.

et al. 2017

Rev. chil. obstet. ginecol.

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RESUMENEl desprendimiento crónico de placenta se caracteriza por la aparición de un sangrado venoso crónico intra o retroplacentario que produce la separación paulatina de la misma. Es poco frecuente y se puede presentar en pacientes sin factores de riesgo. La imagen ecográfica plantea diagnóstico diferencial con la corioamnionitis. El pronóstico fetal es malo especialmente si se asocia con oligoamnios. Se presentan cuatro casos caracterizados por imagen ecográfica característica, retraso del crecimiento fetal, alteración del Doppler, y confirmación anatomopatológica.PALABRAS CLAVE: desprendimiento de placenta, retraso del crecimiento intrauterino, oligoamnios. SUMMARYChronic placental abruption is due to intra or retroplacental insidious bleeding that causes progressive separation from the uterine wall. It is a rare condition and can occur in low risk patients. Chronic abruption imaging poses differential diagnosis with infectious TORCH chorioamnionitis. Fetal prognosis is ominous especially in the presence of oligohydramnios. We present four cases with a common ultrasound appearance, fetal growth restriction, Doppler abnormalities and pathological confirmation.

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Number and size of uterine fibroids and obstetric outcomes

Cited by 109 publications

References 20 publications

Hypovitaminosis D and “small burden” uterine fibroids

Hypovitaminosis D and “small burden” uterine fibroids

Obstetric Outcomes with Large Fibroids in Pregnancies Nearing Term: A Study in a Tertiary Care Centre in Rural India

Evolución y aspectos ecográficos del desprendimiento crónico de placenta.

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