The Myomatous Uterus Complicated by Pregnancy

Successful Outcome of Pregnancy Complicated by Giant Myoma and Severe Heparin-Induced Osteopenia

“…Our patient presents typical characteristics and com plications of a pregnancy combined with myoma [1,2], She is 39 years old and pregnant for the first time preceeded by 3 years of infertility. Pressure symptoms began in the second trimester.…”

“…Reported incidence of uterine fibromas during pregnancy varies from 0.3 to 7.2% [1], They are more frequent in elderly primigravidae, they reduce fertility, and the frequency of sponta neous abortions is increased [1,2], During the second and third trimester of pregnancy the growing tumors may induce pressure symptoms. During late pregnancy and delivery myomas may cause fetal malpresentation, uterine inertia and mechanical dystocia depending on the size and location of the tumor [1], Red degeneration is said to be a common complication during pregnancy [3], Postpartum hemorrhage is a major complication in the puerperium [1], It is controversal whether bigger myomas diminish significantly in size after delivery [2,3], Pregnant women sometimes receive heparin during pregnancy as prophylaxis against thromboembolism. For 20 years it has been known that heparin in nonpregnant subjects for longer periods and exceeding 10,000 units may cause osteopenia [4], Pregnancy may increase the risk of osteopenia from heparin therapy [4][5][6],…”

Myomas, Reproductive Function, and Pregnancy

“…Faulkner, 24 in fact, observed that red degeneration during pregnancy occurs in medium-sized fibroids as opposed to large fibroids in the nonpregnant state. Alternatively, Parks and Barter 25 found that large and pedunculated myomas present a higher risk of developing red degeneration. Red degeneration has been suggested to appear on a sonogram as an area of high through transmission with moderate to marked echoes, 15,26 and Lev-Toaff and colleagues 18 observed that 10 of 113 patients with myomas during pregnancy developed a cystic space or a coarse heterogenous echotexture pattern: seven patients of this group experienced recurrent episodes of abdominal pain that required hospitalization.…”

“…Moreover, the common belief that submucous myomas are associated with heavy postpartum bleeding is based only on anecdotal reports. 25,55 Campbell 8 in his series of 142 women with myomas identified eight cases of adherent placenta that required manual removal, and he theorized that adherent placenta may be due to the absence of normal endometrium at the site of implantation and to the consequent development of a defective decidua basalis. Adherent placenta must not be confused with a retained placenta that has failed to be expelled because of uterine atony or obstruction of uterine cavity.…”