EFFECT OF LEIOMYOMA ON MATERNAL AND FETAL OUTCOMES DURING PREGNANCY

Öz

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.

Anahtar Kelimeler

• maternal outcomes
• fetal outcomes
• leiomyoma

LEİOMYOMUN MATERNAL VE FETAL SONUÇLAR ÜZERİNE ETKİSİ

Öz

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.

Anahtar Kelimeler

• maternal sonuçlar
• fetal sonuçlar
• leiomyoma

Kaynakça

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