Morgan OF, Piña RB, Elorriaga GE, Báez BJ, Quevedo CE, Peraza GFJ

Language: Spanish
References: 18
Page: 467-473
PDF size: 324.31 Kb.

ABSTRACT

Background: The association of uterine leiomyoma and pregnancy is increasing due to the tendency of couples to delay first pregnancy after age 30. The risk of uterine fibroids is greater with advancing age of the woman.
Objective: To evaluate the impact of fibroids on the incidence of complications during pregnancy, labor and delivery.
Patients and methods: We observed 65 pregnant patients with uterine fibroids and 165 pregnant patients without fibroids. Follow-up ultrasound was performed at weeks 20 to 24, 30 to 32 and 36 to 40. We analyzed the following variables: threatened abortion, pregnancy loss, preterm birth, premature rupture of membranes, abnormal fetal presentation, mode of termination of pregnancy, uterine atony, postpartum hemorrhage and perinatal outcome.
Results: The frequency of threatened abortion, risk of pregnancy loss in the second trimester, preterm births, premature rupture of membranes and abnormal fetal presentation was significantly higher in patients with uterine fibroids compared to patients without fibroids. It was not demonstrated that fibroids grow during follow-up even, there was a trend toward reduction in size as pregnancy progressed and until its completion. No significant differences in the frequency of cesarean section between groups (52.3 vs. 47.9%, RR 1.09; 95% CI 0.82-1.45, p=0.646). Uterine atony was more frequent in patients with fibroids than in patients without fibroids (12.3 vs 4.2%, RR=2.9, 95% CI 1.2-7.6, p=0.036). There were no differences in perinatal outcomes between the groups.
Conclusions: Uterine fibroids increase the risk of complications during pregnancy and childbirth. Could not be demonstrated an increased risk of caesarean section.

REFERENCES

1. Rice JP, Kay HH, Mahony BS. The clinical significance of uterine leiomyomas in pregnancy. Am J Obstet Gynecol 1989;160:1212-1216.

2. Laughlin SK, Baird DD, Savitz DA, Herring AH, Hartmann KE. Prevalence of uterine leiomyomas in the first trimester of pregnancy: an ultrasound-screening study. Obstet Gynecol 2009;113:630-635.

3. Stout MJ, Odibo AO, Graseck AS, Macones GA, Crane JP, et al. Leiomyomas at routine second-trimester ultrasound examination and adverse obstetric outcomes. Obstet Gynecol 2010;116:1056-1063.

4. Coronado GD, Marshall LM, Schwartz SM. Complications of pregnancy, labor, and delivery with uterine leiomyomas: a population-based study. Obstet Gynecol 2000;95:764-769.

5. Kulikowska-Ciecielag K, Ploszynski A, Damdinsuren A, Leszczynska K, Mielnik J. Myomas and pregnancy-obstetrics dilemma of the next decade? Ginekol Pol 2002;73(4):284-287.

6. Aharoni A, Reiter A, Golan D, Paltiely Y, Sharf M. Patterns of growth of uterine leiomyoma during pregnancy. A prospective longitudinal study. Br J Obstet Gynaecol 1988;95:510-513.

7. Rosati P, Exacoustos C, Mancuso S. Longitudinal evaluation of uterine myoma growth during pregnancy. J Ultrasound Med 1992;11:511-516.

8. Strobelt N, Ghidini A, Cavallone M, et al. Natural history of uterine leiomyomas in pregnancy. J Ultrasound Med 1994;13:399-403.

9. Katz VL, Dotters DJ, Droegemeuller W. Complications of uterine leiomyomas in pregnancy. Obstet Gynecol 1989;73:593-596.

10. Vergani P, Ghidini A, Strobelt N, Roncaglia N, Locatelli A, et al. Do uterine leiomyomas influence pregnancy outcome? Am J Perinatol 1994;11:356-358.

11. Sheiner E, Bashiri A, Levy A, Hershkovits R, Katz M, et al. Obstetrics characteristics and perinatal outcome of pregnancies with uterine leiomyomas. J Reprod Med 2004;49:182-186.

12. Roberts WE, Fulp KS, Morrison JC, Martin JN. The impact of leiomyomas on pregnancy. Aust NZ J Obstet Gynaecol 1999;39:43-47.

13. Benson CB, Chow JS, Chang-Lee W, et al. Outcome of pregnancies in women with uterine leiomyomas identified by sonography in the first trimester. J Clin Ultrasound 2001;29(5):261-264.

14. Salvador E, Bienstock J, Blackemore KJ, Presuman E. Leyomiomata uteri, genetic amniocentesis and the risk of second trimester spontaneous abortion. Am J Obstet Gynecol 2002;186:913-915.

15. Qidwai GI, Caughey AB, Jacoby AF. Obstetric outcomes in women with sonographically identified uterine leiomyomata. Obstet Gynecol 2006;107(2 Pt 1):376-382.

16. Exacoustos C, Rosati P. Ultrasound diagnosis of uterine myomas and complications in pregnancy. Obstet Gynecol 1993;82:97-101.

17. Davis JL, Ray-Mazumder S, Hobel CJ, Baley K, Sassoon D. Uterine leiomyomas in pregnancy: a prospective study. Obstet Gynecol 1990;75:41-44.

18. Lev-Toaff AS, Coleman BG, Arger PH, et al. Leiomyomas in pregnancy: sonographic study. Radiology 1987;164:375-380.