Uterine Fibroids and Pregnancy: A Review of the Challenges from a Romanian Tertiary Level Institution

Abstract

Background and Objectives. Uterine fibroids are relatively common in reproductive-age women and are directly linked to pregnancy. There are many debates about performing a myomectomy at the same time as a caesarian section (CS) in such cases due to the risk of a hemorrhage. Our study aims to investigate fibroid features and their evolution in pregnancy, complications of a myomectomy during CS and maternal and fetal obstetric outcomes of pregnancies with fibroids. Materials and methods. We realize a prospective study that includes 57 patients with fibroids in pregnancy diagnosed in January 2017–June 2019. We analyze the number, the location and the growth of fibroids during pregnancy and the maternal and fetal outcome. We appreciate the bleeding in patients with a myomectomy and without a myomectomy during CS, using hemoglobin values before and after birth. Results. Most of the patients present single fibroids that are 30–160 mm in size, located on the anterior uterine wall. Vaginal delivery is used in 7% of women, whereas 85.96% deliver by CS. In addition, 68% of fibroids are diagnosed in the first trimester. In most cases, the fibroid has maximum growth in the second trimester of pregnancy. The myomectomy rate for fibroids during CS is 24.48. Hemoglobin values showed no statistically significant difference between the two groups with and without myomectomy. The operating time is double for the group with a myomectomy associated with a CS. The results of the obstetric outcomes are abortion in 7% of all patients, whereas premature delivery and births at term are 9.43% and 90.57%, respectively. Conclusions. The decision of performing a myomectomy during pregnancy can be a challenge and must be performed for selected cases. This procedure may have several benefits, such as avoiding another operation to remove fibroids.

Experience in managing Myomas: A case series

“…As per the largest study done of fibroids complicating pregnancy in Romanian tertiary care hospital in 2022, vaginal delivery were in 7% of the cases, with caesarean delivery in 85.96%.68% were diagnosed in the first trimester and the myomectomy rate was 24.48%. 4 In case 5, the fibroid was an incidental finding which was not recognised in scan. Successful myomectomy was achieved without further post operative complications.…”

Overcoming Obstacles During Caesarean Section with a Fibroid in the Uterus, from Diagnosis to Decision: A Case Series

“…There was no growth or decrease in myoma size in any of them. In contrast with Benaglia et al, who, in their prospective cohort research on 25 women with fibroids, reported that the sizes of the fibroids dramatically increased to more than double their original sizes during the first seven weeks of pregnancy, Tîrnovanu et al observed change in the maximal rise occurred in the second trimester [ 10 , 17 ]. Nevertheless, Rosati et al discovered that up to 78% of uterine fibroids do not demonstrate significant growth during pregnancy [ 18 ].…”

“…Physical inspection can only detect big fibroids, and ultrasound's capacity to identify fibroids in pregnancy is even more limited due to the foetus [ 9 ]. Hence, the prevalence of uterine fibroids during pregnancy is underestimated [ 10 ].…”

U xơ tử cung và thai nghén: báo cáo ca bệnh và tổng quan tài liệu

“…Các giả thuyết được đưa ra: đầu tiên u xơ có thể cản trở quá trình hình thành bánh rau và phát triển tuần hoàn tử cung bình thường, thường gặp ở những khối u xơ dưới niêm mạc lớn nhô vào trong buồng tử cung. Thứ hai sự phát triển nhanh chóng của u xơ có hoặc không có sự thoái hóa dẫn tới tăng co bóp tử cung gây sảy thai [6]. Tuy nhiên, trong một phân tích tổng hợp của 9 nghiên cứu trên 21829 thai kỳ bao gồm 1394 đối tượng có u xơ tử cung và 20435 đối tượng còn lại không có, khi không xem xét vị trí của u xơ thì không tìm thấy mối liên quan giữa sự hiện diện của u xơ tử cung và sảy thai [7].…”