DOI: http://dx.doi.org/10.18203/2320-1770.ijrcog20212330

Fetomaternal outcome in fibroid complicating pregnancy: a retrospective study

Suneela Mullakkal Sankaran, Jayasree Sukumara Pillai

Abstract


Background: Fibroids are the commonest benign tumour arising from the smooth muscle from uterus. Effects of fibroids on pregnancy and the effects of pregnancy on fibroids are a frequent clinical concern since these tumors are common in women of reproductive age. Most pregnant women with fibroids do not have any complications during pregnancy related to the fibroids. Pain is the most common problem and there may be a slightly increased risk of obstetrical complications like miscarriage, preterm labor and delivery, malpresentation and placental abruption.

Methods: A retrospective study was carried out to study the fetomaternal complications in fibroid complicating pregnancies. Duration of study period was one year. Study was from 1 January 2019 to 31 December 2019 in government medical college, Kozhikode. Patients beyond 28 weeks of gestational age with fibroid complicating pregnancies were included. Case records were reviewed from medical records library government medical college, Kozhikode. Detailed review of patients including history, examination and ultrasound scan reports, mode of delivery, antepartum, intrapartum, postpartum complications and details of babies were also taken.

Results: During the study period a total of 112 cases of fibroid complicating pregnancies were included in the study out of 15875 total number of deliveries. Majority of patients belonged to age group between 30 to 35 years (40.17%) and 28.1% belonged to between 35 and40 years. 63.39% of patients were multies. In most of the cases fibroid was diagnosed by the first trimester ultra sound itself. Size of uterus remained corresponding to gestational age in more than half of cases (56.25%). There was increased incidence of caesarean delivery (56.25%), preterm delivery (7.2%) and placenta praevia (2.8%) postpartum haemorrhage (10.71%) in the studied cases.

Conclusions: Fibriod complicating pregnancies are associated with higher incidence of obstetric complications during all the phases of pregnancy. Proper antenatal care and assessment can reduce the adverse outcomes to a greater extent.


Keywords


Fibroid, Fetomaternal, Ultrasound, Gestational age, Obstetric complications

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References


Cramer SF, Patel A. The frequency of uterine leiomyomas. Am J ClinPathol. 1990;94(4):435-8

Somigliana E, Vercellini P, Daguati R, Giorgi O, Crossignani PG. Fibroids and female reproduction: a critical analysis of the evidence. Hum Reprod Update. 2007;13(5);465-76.

Guo XC, Segars JH. The impact and management of fibroids for fertility: an evidence-based approach. Obstet Gynecol Clin North Am. 2012;39(4):521-33.

Qidwai GI, Caughey AB, Jacoby AF. Obstetric outcomes in women with sonographically identified leiomyomata. Obstet Gynecol. 2006;107;376-82.

Burton CA, Grimes DA, March CM. Surgical management of leiomyomata during pregnancy. Obstet Gynecol.1989;74(5):707-9.

Rice JP, Kay HH, Mahony BS. The clinical significance of uterine leiomyomas in pregnancy. Am J Obstet Gynecol.1989;160:1212-6.

Cooper NP, Okolo S. Fibroids in pregnancy common but poorly understood. Obstet Gynecol Surv. 2005;60(2):132-8.

Vivo A, Mancuso A, Giacobbe A, Savasta LM, Dominici RD, Dugo N, et al. Uterine myomas during pregnancy: a longitudinal sonographic study. Ultrasound Obstet Gynecol. 2011;37(3):361-5.

Katz VL, Dotters DJ, Droegemueller W. Complications of uterine leiomyomas in pregnancy. Obstet Gynecol. 1989;73(4):593-6.

Stout MJ, Odibo AO, Graseck AS, Macones GA, Crane JP, Cahill AG. Leiomyomas at routine second-trimester ultrasound examination and adverse obstetric outcomes. Obstet Gynecol. 2010;116(5):1056-63.

Cook H, Ezzati M, Segars JH, McCarthy D. The impact of uterine leiomyomas on reproductive outcomes. Minerva Ginecol. 2010;62(3):225-36.

Aharoni A, Reiter A, Golan D, Paltiely Y, Sharf M. Patterns of growth of uterine leiomyomas during pregnancy. A prospective longitudinal study. Br J Obstet Gynaecol. 1988;95(5):510-3.

Rosati P, Exacoustòs C, Mancuso S. Longitudinal evaluation of uterine myoma growth during pregnancy. A sonographic study. J Ultrasound Med. 1992;11(10):511-5.

Lev-Toaff AS, Coleman BG, Arger PH, Mintz MC, Arenson RL, Toaff ME. Leiomyomas in pregnancy: sonographic study. Radiology. 1987;164(2):375-80.

Zimmermann A, Bernuit D, Gerlinger C, Schaefers M, Geppert K. Prevalence, symptoms and management of uterine fibroids: an international internet-based survey of 21,746 women. BMC Women's Health. 2012;12(1):1-1.

Carolis SD, Fatigante G, Ferrazzani S, Trivellini C, Santis LD, Mancuso S, et al. Uterine myomectomy in pregnant women. Fetal Diagn Ther. 2001;16(2):116-9.

Parker WH. Etiology, symptomatology, and diagnosis of uterine myomas. Fertil Steril. 2007;87(4):725-36.

Muram D, Gillieson M, Walters JH. Myomas of the uterus in pregnancy:ultrasonographic follow-up. Am J Obstet Gynecol. 1980;138(1):16-9.

Winer-Muram HT, Muram D, Gillieson MS. Uterinemyomas in pregnancy. J Can Assoc Radiol. 1984;35(2):168-70.

Gabbe SG, Niebyl JR, Simpson JL. Obstetrics: Normal and problem pregnancies. 4th ed. Pennsylvania: Churchill Livingstone; 2008: 739.

Michalas SP, Oreopoulou FV, Papageorgiou JS. Myomectomy during pregnancy and caesarean section. Hum Reprod. 1995;10(7):1869-70.

Ehigiegba AE, Ande AB, Ojobo SI. Myomectomy during cesarean section. Int J Gynaecol Obstet. 2001;75(1):21-5.

Coronado GD, Marshall LM, Schwartz SM. Complications in pregnancy, labor and delivery with uterine leiomyomas: a population-based study. Obstet Gynecol. 2000;95(5):764-9.

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(3):630-5.

Baird DD, Dunson DB, Hill MC, Cousins D, Schectman JM. High cumulative incidence of uterine leiomyoma in black and white women: ultrasound evidence. Am J Obstet Gynecol. 2003;188(1):100-7.

Shavell VI, Thakur M, Sawant A, Kruger ML, Jones TB, Singh M, et al. Adverse obstetric outcomes associated with sonographically identified large uterine fibroids. Fertil Steril. 2012;97(1):107-10.

Cooper NP, Okolo S. Fibroids in pregnancy-common but poorly understood. Obstet Gynecol Surv. 2005;60(2):132-8.

Klatsky PC, Tran ND, Caughey AB, Fujimoto VY. Fibroids and reproductive outcomes: a systematic literature review from conception to delivery. Am J Obstet Gynecol. 2008;198(4):357-66.

Sun K, Xie Y, Zhao N, Li Z. A case control study of the relationship between visceral fat and development of uterine fibroids. Experiment Therapeut Med. 2019;18(1):404-10.

Chen CR, Buck GM, Courey NG, Perez KM, Wactawski-Wende J. Risk factors for uterine fibroids among women undergoing tubal sterilization. Am J Epidemiol. 2001;153(1):20-6.

Okolo S. Incidence, aetiology and epidemiology of uterine fibroids. Best Pract Res Clin Obstet Gynecol. 2008;22(4):571-88.

Wise LA, Palmer JR, Harlow BL, Spiegelman D, Stewart EA, Adams-Campbell LL, et al. Reproductive factors, hormonal contraception, and risk of uterine leiomyomata in African-American women: a prospective study. Am J Epidemiol. 2004;159(2):113-23.

Marshll LM, Spiegelman D, Goldman MB, Manson JE, Colditz GA, Barbieri RL, et al. A prospective study of reproductive factors and oral contraceptive use in relation to the risk of uterine leiomyomata. Fertil Steril. 1998;70(3):432-9.

Lee HJ, Norwitz ER, Shaw J. Contemporary management of fibroids in pregnancy. Rev Obstet Gynecol. 2010;3(1):20-7.

Karlsen K, Kesmodel SU, Mogensen O, Humaidan P, Ravn P. Relationship between a uterine fibroid diagnosis and the risk of adverse obstetrical outcomes: a cohort study. BMJ Open. 2020;10(2):032104.

Noor S, Fawwad A, Sultana R, Bashir R, Qurat-ul-ain, Jalil H, et al. Pregnancy with fibroids and its and its obstetric complication. J Ayub Med Coll Abbottabad. 2009;21(4):37-40.

Ezzedine D, Norwitz E. Are women with uterine fibroids at increased risk for adverse pregnancy outcome? Clin Obstet Gynecol. 2016;59(1):119-27

Ciavattini A, Clemente N, Carpini GD, Giuseppe JD, Giannubilo SR, Tranquilli AL. Number and size of uterine fibroids and obstetric outcomes. The journal of maternal-fetal and neonatal medicine: the official journal of the European Association of Perinatal Medicine, the Federation of Asia and Oceania Perinatal Societies, the International Society of Perinatal Obstet. Res Gate. 2015;28(4):484-8.

Parazzini F, Tozzi L, Bianchi S. Pregnancy outcome and uterine fibroids. Best Pract Res Clin Obstet Gynaecol. 2016;34:74-84.

Kramer MS, Berg C, Abenhaim H, Dahhou M, Rouleau J, Mehrabadi A, et al. Incidence, risk factors, and temporal trends in severe postpartum hemorrhage. Am J Obstetr Gynecol. 2013;209(5):441-7.

Navid S, Arshad S, Qurat-ul A, Meo RA. Impact of leiomyoma in pregnancy. JAMC. 2012;24(1):90-2.

Zaima A, Ash A. Fibroid in pregnancy: characteristics, complications, and management. Postgrad Med J. 2011;87(1034):819-28.

Zhao R, Wang X, Zou L, Li G, Chen Y, Li C, et al. Adverse obstetric outcomes in pregnant women with uterine fibroids in China: A multicenter study involving 112,403 deiveries. PLoS One. 2017;12(11):0187821.

Dasgupta A, Santra D, Talukdar A, Ghosh U, Narayan S, Dasgupta S. Obstetric outcomes with large fibroids in pregnancies near term: a study in a tertiary care centre in Rural India. Obstet Gynecol Int J. 2017;7(2):00244.