EFFECT OF LEIOMYOMA ON MATERNAL AND FETAL OUTCOMES DURING PREGNANCY

Year 2022, Volume: 19 Issue: 2, 1246 - 1254, 01.07.2022

Deniz Oluklu , Serra Akar , Ali Çağlar

https://doi.org/10.38136/jgon.954924

Abstract

Aim: The study aimed to determine the effects of leiomyoma size, number, location, and type on obstetric and fetal outcomes, retrospectively.
Materials and Method: A total of 292 singleton pregnancies, who were attended to perinatology unit of Zekai Tahir Burak Women’s Health Training and Research Hospital in Ankara as part of routine antenatal follow-up between January 2007 and 2014 and delivered at or beyond 24 weeks were included. The study group consisted of patients with leiomyoma of 4 cm or more. Patients who underwent myomectomy during cesarean delivery, who had co-morbidities, uterine anomalies, or fetal malformations were excluded from the study. Obstetric and fetal outcomes were recorded.
Results: Vaginal delivery rate was significantly higher in patients with a single leiomyoma when compared to patients with 2 or more leiomyoma (p=0.009). Diagnosis of preterm labor was significantly higher in patients with leiomyoma size larger than 10 cm when compared to patients with leiomyoma sizes 4-7 cm and 7-10 cm (p =0.005 and p=0.002, respectively). The presentation anomaly rate was significantly higher in patients with leiomyoma sizes bigger than 10 cm when compared to patients with leiomyoma sizes 4-7 cm (p=0.008) and 7-10 cm (p =0.045). The need for transfusion was lower in the group with leiomyoma measuring 4-7 cm when compared to leiomyoma measuring 7-10 cm and those larger than 10 cm (p=0.010 and p = 0.011, respectively). Cesarean delivery rate was higher in patients with leiomyoma localized to the cervix and corpus in comparison to those localized to the corpus only (p =0.008). Vaginal delivery rate (40.9%) was higher in patients with intramural leiomyoma when compared to subserous (p=0.002) and combined (p=0.004) leiomyoma.
Conclusion: The prevalence of leiomyoma during pregnancy is increasing due to women planning pregnancy later in life, the increasing incidence of fibroids with age, and the rise of cesarean delivery rates which enables us to diagnose more cases in recent years. Patients with leiomyoma should be placed on close surveillance for possible complications during pregnancy, delivery and postpartum.

Keywords

maternal outcomes, fetal outcomes, leiomyoma

LEİOMYOMUN MATERNAL VE FETAL SONUÇLAR ÜZERİNE ETKİSİ

Abstract

Amaç: Çalışmamızda myom boyutu, sayısı, lokalizasyonu ve tipinin obstetrik ve fetal sonuçlar üzerindeki etkilerinin retrospektif olarak elde edilmesi amaçlanmıştır.
Gereçler ve Yöntem: Ocak 2007-Aralık 2014 tarihleri arasında Ankara Dr Zekai Tahir Burak Eğitim ve Araştırma Hastanesi perinataloji kliniğinde rutin antenatal takibi yapılan ve 24 hafta ve üzeri doğum yapmış 292 tekil gebe çalışmaya dahil edildi. Çalışma grubu 4 santimetre ve üzeri leiomyomu olan hastalardan oluşturuldu. Sezaryen esnasında myomektomi yapılan, ek hastalığı, uterin anomalisi ve fetal malformasyonu olan hastalar çalışma dışı bırakıldı. Obstetrik ve fetal sonuçlar kaydedildi.
Bulgular: Çalışmamızda myom sayısı 1 olanlarda vajinal doğum şekli görülme oranı myom sayısı 2 ve daha fazla olanlardan anlamlı düzeyde yüksek bulunmuştur (2= 6.922; p=0.009).
Myom boyutu 10 cm'den fazla olanlarda preterm eylem tanısı alanların oranı 4-7 cm ve 7 -10 cm olanlardan anlamlı düzeyde yüksek bulunmuştur (sırasıyla, p= 0.005 ve p= 0.002). Myom boyutu 10 cm'den fazla olanlarda prezentasyon anomalisi olanların oranı 4-7 cm (p= 0.008) ve 7-10 cm olanlardan daha yüksektir (p=0.045). 4-7 cm grubunda tranfüzyon ihtiyacı olanların oranı 7-10 cm grubundan ve ˃10 cm grubundan düşüktür (sırasıyla, p= 0.010 ve p= 0.011).Myom yerleşimi serviks ile korpus lokalizasyonlu myomu olanlarda korpus lokalizasyonlu olanlara göre sezeryan ile doğumun daha yüksek sıklıkta olduğunu tespit ettik (p= 0.008).İntramural grubunda vajinal doğum oranı % 40.9, subserozal (p= 0.002) ve kombine (p= 0.004) olup myom tipi gruplarında elde edilen oranlardan daha yüksek bulunmuştur.
Sonuç: Kadınların daha ileri yaşlarda gebelik planması, ileri yaşlarda myoma uteri insidansının artması ve son yıllarda sezaryen ile doğum oranlarının artmasıyla gebelik sırasında myoma uteriye sık rastlanmaktadır. Myomların sayısı, boyutu, yerleşimi ve tipine göre gebeliğe etkisi ve obstetrik sonuçları ile ilişkili litaratürde az çalışma olup, çelişkili kanıtlar mevcuttur. Myomu olan olgular gebelik, doğum ve doğum sonrası olası komplikasyonlar yönünden dikkatlice takip edilmelidir.

Keywords

maternal sonuçlar, fetal sonuçlar, leiomyoma

References

• Practice Committee of the American Society for Reproductive Medicine. Myomas and reproductive function. Fertil Steril 2004; 82:S111–6.
• Rice JP, Kay HH, Mahony BS. The clinical significance of uterine leiomyomas in pregnancy. Am J Obstet Gynecol 1989;160:1212–6.
• Exacoustos C, Rosati P. Ultrasound diagnosis of uterine myomas and complications in pregnancy. Obstet Gynecol 1993;82:97–101.
• Katz VL, Dotters DJ, Droegemueller W. Complications of uterine leiomyomas in pregnancy. Obstet Gynecol 1989;73:593–6.
• Burton CA, Grimes DA, March CM. Surgical management of leiomyomata during pregnancy. Obstet Gynecol 1989;74:707–9.
• Hasan F, Arumugam K, Sivanesaratnam V. Uterine leiomyomata in pregnancy. Int J Gynaecol Obstet 1991;34:45–8.
• Winer-Muram HT, Muram D, Gillieson MS. Uterine leomyomas in pregnancy. J Can Assoc Radiol 1984;35:168-70.
• Coronado GD, Marshall LM, Schwartz SM. Complications in pregnancy, labor, and delivery with uterine leiomyomas: a population-based study. Obstet Gynecol 2000;95:764–9.
• 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;113:630–5.
• Qidwai GI, Caughey AB, Jacoby AF. Obstetric outcomes in women with sonographically identified uterine leiomyomata. Obstet Gynecol 2006;107(2 Pt 1):376–82.
• Vergani P, Locatelli A, Ghidini A, Andreani M, Sala F, Pezzullo JC. Large uterine leiomyomata and risk of cesarean delivery. Obstet Gynecol 2007;109(2 Pt 1):410–4.
• Chen YH, Lin HC, Chen SF, Lin HC. Increased risk of preterm births among women with uterine leiomyoma: a nationwide population-based study. Hum Reprod 2009;24:3049–56.
• Sheiner E, Bashiri A, Levy A, Hershkovitz R, Katz M, Mazor M. Obstetric characteristics and perinatal outcome of pregnancies with uterine leiomyomas. J Reprod Med 2004;49:182–6.
• Davis JL, Ray-Mazumder S, Hobel CJ, Baley K, Sassoon D. Uterine leiomyomas in pregnancy: a prospective study. Obstet Gynecol 1990;75:41–4.
• Ciavattini A, Di Giuseppe J, Stortoni P, Montik N, Giannubilo SR, Litta P, et al. Uterine fibroids: pathogenesis and interactions with endometrium and endomyometrial junction. Obstetrics and gynecology international. 2013;2013:173184.
• Shavell IV, Thakur M, Anjali S, et al. Adverse obstetric outcomes associated with sonograhically identified large uterine fibroids. Fertil Steril. 2012;97: 0015-0282.
• Lam S-J, Best S, Kumar S. The impact of fibroid characteristics on pregnancy outcome. Am J Obstet Gynecol 2014;211:395.e1-5.
• Patrizia Vergani, Alessandro Ghidini, Nicola Strobelt et all. Do Uterine Leiomyomas Influence Pregnancy Outcome? American Journal of Perinatalogy 11(5):356-8 • September 1994.
• Stout MJ, Odibo AO, Graseck AS et all. Leiomyomas at routine second trimester ultrasound examination and adverse obstetric outcomes. Obstetrics & Gynecology: Nov 2010 - Volume 116, No. 5.
• Conti N, Tosti C, Pinzauti S et all. Uterine fibroids affect pregnancy outcome in woman over 30 year old: role of other risk factors. The Journal of Maternal-Fetal Medicine,2013; 26(6):584-587.