Surgical and Conservative Management of Symptomatic Leiomyomas during Pregnancy: a Retrospective Pilot Study

Abstract

Introduction !Leiomyomas (fibroids or myomas) are common benign myometrial neoplasms composed of smooth muscle [1]. Leiomyomas represent the primary indication for hysterectomy in the United States, Germany, France and England and are estimated to occur in 20-80% of reproductive-age Abstract ! Purpose: Evidence regarding distinguishing characteristics of women with symptomatic leiomyomas during pregnancy who undergo myomectomy during pregnancy and those who respond to conservative treatment is sparse because it mostly derives from case reports and small patient series. As the first of its type, the present study analyzed the characteristics of women with symptomatic leiomyomas treated with myomectomy during pregnancy and those treated conservatively. Methods: We performed a computer search of medical records from 1 January 2001 to 31 March 2011 using the International Classification of Diseases Codes for pregnancy, myomectomy and leiomyomas during pregnancy. Results: 27 patients were admitted during pregnancy directly related to leiomyomas; 17 of the 27 patients received conservative treatment for symptomatic leiomyomas, and 10 patients had surgery during pregnancy: 3 had undergone diagnostic surgical procedures and 7 myomectomy. Perioperative and postoperative morbidity was low in all women in our sample. Conclusion: In our pilot study, myomectomy during pregnancy was safely performed in carefully selected patients, with subserosal or pedunculated leiomyomas that failed to respond to conservative treatment, with low perioperative and postoperative morbidity. Zusammenfassung

Symptomatic uterine fibroids in pregnancy — wait or operate? Own experience

“…If they do not threaten the development of pregnancy in a direct way, however, they make it difficult to deliver or may result in post-partum hysterectomy, it is possible to perform myomecotmy during caesarean section. Nowadays, it is believed that every effort should be made to avoid caesarean section, taking myomectomy case into consideration, due to a reasonable risk of severe haemorrhage requiring blood transfusion, uterine artery ligation and / or intra-and post-operative hysterectomy [13][14][15].…”

Evaluating the Acute Abdomen in the Pregnant Patient

“…They have been associated with a variety of different obstetric complications including spontaneous abortion, fetal malpresentation, intrauterine growth restriction, placenta previa, labor dystocia, PA, retained placenta, preterm labor, premature rupture of membranes, postpartum hemorrhage, and an increased frequency of cesarean sections. 44 Leiomyomas are often asymptomatic during pregnancy. Abdominal pain and uterine contractions can result from their degeneration and necrosis.…”

Features of giving aid to pregnant women with uterine leiomyoma

“…The complicated course of pregnancy in women with uterine leiomyoma occurs in approximately 10.0 to 40.0 % of cases [5,12]. Obstetric complications as threatened miscarriage, preterm labor, premature detachment of a normally located placenta, late gestosis, breech presentation and malposition may occur during pregnancy.…”

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Introduction.In recent years, one of the most current issues of modern obstetric and gynecological practice remains the problem of uterine leiomyoma in women of reproductive age. Nowadays, it occurs in 40.0-60.0 % of cases [8,12,13]. Consequently, the combination of pregnancy and this pathology has been increased by 20.0 %.

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“…A series of studies, both national and foreign authors, are dedicated to the search for modern treatment methods of this condition in pregnant women. Unfortunately, many issues remain unsolved and controversial, especially regarding the surgical treatment of pregnant women with the presence of indicated pathology; there are no generally accepted standards for pregnancy and delivery of these patients.Different degrees of developmental risk of obstetric and perinatal complications are determined by women's age exacerbated by hereditary, obstetric, gynecological and somatic anamnesis; localization, tumor size; severity of pathological changes in the uterus and systemic changes in the body caused by the development of tumor process [1,2,4,11].The complicated course of pregnancy in women with uterine leiomyoma occurs in approximately 10.0 to 40.0 % of cases [5,12]. Obstetric complications as threatened miscarriage, preterm labor, premature detachment of a normally located placenta, late gestosis, breech presentation and malposition may occur during pregnancy.…”