51
|
Levy G, Hill MJ, Beall S, Zarek SM, Segars JH, Catherino WH. Leiomyoma: genetics, assisted reproduction, pregnancy and therapeutic advances. J Assist Reprod Genet 2012; 29:703-12. [PMID: 22584729 DOI: 10.1007/s10815-012-9784-0] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2012] [Accepted: 04/24/2012] [Indexed: 12/12/2022] Open
Abstract
PURPOSE Uterine leiomyomas are common, benign, reproductive tract tumors affecting a majority of reproductive aged women. They are associated with gynecologic morbidity and detrimentally affect reproductive potential. The etiology of leiomyomas is poorly understood and their diagnosis prior to treatment with Assisted Reproductive Technologies (ART) represents a management dilemma. The purpose of this paper is to review known genetic and molecular contributions to the etiologies of leiomyomas, describe their impact on ART outcomes and reproductive potential, and review alternative therapies and future directions in management. METHODS A critical review of the literature pertaining to genetic component of uterine leiomyomas, their impact on ART and pregnancy and leiomyoma therapeutics was performed. RESULTS Uterine leiomyomas are characterized by complex molecular mechanisms. Their location and size determines their potential detriment to ART and reproductive function and novel therapeutic modalities are being developed. CONCLUSION The high prevalence of uterine leiomyomas and their potential detrimental influence on ART and reproductive function warrants continued well-designed studies to ascertain their etiology, optimal treatment and novel less morbid therapies.
Collapse
Affiliation(s)
- Gary Levy
- Program in Reproductive and Adult Endocrinology, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institute of Health, Bethesda, MD, USA.
| | | | | | | | | | | |
Collapse
|
52
|
Rovio PH, Heinonen PK. Pregnancy outcomes after transvaginal myomectomy by colpotomy. Eur J Obstet Gynecol Reprod Biol 2012; 161:130-3. [DOI: 10.1016/j.ejogrb.2011.12.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2011] [Revised: 11/12/2011] [Accepted: 12/06/2011] [Indexed: 10/28/2022]
|
53
|
Hors fertilité, place de la myomectomie en périménopause et après la ménopause. ACTA ACUST UNITED AC 2011; 40:902-17. [DOI: 10.1016/j.jgyn.2011.09.024] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
|
54
|
Hayasaka S, Arai M, Ugajin T, Fujii O, Nabeshima H, Uthunomiya H, Yokomizo R, Yuki H, Terada Y, Murakami T, Yaegashi N. Factors Affecting Fertility Following Laparoscopic Myomectomy. J Gynecol Surg 2011. [DOI: 10.1089/gyn.2010.0024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Shinichi Hayasaka
- Department of Obstetrics and Gynecology, Tohoku University School of Medicine, Sendai, Miyagi, Japan
| | - Maiko Arai
- Department of Obstetrics and Gynecology, Tohoku University School of Medicine, Sendai, Miyagi, Japan
| | - Tomohisa Ugajin
- Department of Obstetrics and Gynecology, Tohoku University School of Medicine, Sendai, Miyagi, Japan
| | - Osamu Fujii
- Department of Obstetrics and Gynecology, Tohoku University School of Medicine, Sendai, Miyagi, Japan
| | - Hiroshi Nabeshima
- Department of Obstetrics and Gynecology, Tohoku University School of Medicine, Sendai, Miyagi, Japan
| | - Hiroki Uthunomiya
- Department of Obstetrics and Gynecology, Tohoku University School of Medicine, Sendai, Miyagi, Japan
| | - Rei Yokomizo
- Department of Obstetrics and Gynecology, Tohoku University School of Medicine, Sendai, Miyagi, Japan
| | - Hiromithu Yuki
- Department of Obstetrics and Gynecology, Tohoku University School of Medicine, Sendai, Miyagi, Japan
| | - Yukihiro Terada
- Department of Obstetrics and Gynecology, Tohoku University School of Medicine, Sendai, Miyagi, Japan
| | - Takashi Murakami
- Department of Obstetrics and Gynecology, Shiga University of Medical Science, Othu, Shiga, Japan
| | - Nobuo Yaegashi
- Department of Obstetrics and Gynecology, Tohoku University School of Medicine, Sendai, Miyagi, Japan
| |
Collapse
|
55
|
Bendifallah S, Brun JL, Fernandez H. Place de la myomectomie chez une patiente en situation d’infertilité. ACTA ACUST UNITED AC 2011; 40:885-901. [DOI: 10.1016/j.jgyn.2011.09.014] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
56
|
Place des myomectomies en situation de conception spontanée ou chez la femme désireuse de préserver sa fertilité. ACTA ACUST UNITED AC 2011; 40:875-84. [DOI: 10.1016/j.jgyn.2011.09.023] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
|
57
|
Intrauterine Adhesions following Conservative Treatment of Uterine Fibroids. Obstet Gynecol Int 2011; 2012:853269. [PMID: 22190959 PMCID: PMC3236427 DOI: 10.1155/2012/853269] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2011] [Accepted: 10/17/2011] [Indexed: 01/02/2023] Open
Abstract
Uterine fibroids are common in women of reproductive age and various conservative treatments are available. In order to achieve a successful conservative treatment of fibroids, functional integrity of the uterus is as important as tumor removal or symptoms relief. In this context, intrauterine adhesions must be recognized as a possible complication of conservative management of uterine fibroids, but diagnostic pitfalls might justify an underestimation of their incidence. Hysteroscopic myomectomy can cause adhesions as a result of surgical trauma to the endometrium. The average reported incidence is around 10% at second-look hysteroscopy, but it is higher in certain conditions, such as the case of multiple, apposing fibroids. Transmural myomectomies also have the potential for adhesion, especially when combined with uterine ischemia. Uterine arteries embolization also carries a risk of intracavitary adhesions. Prevention strategies including bipolar resection, barrier gel or postoperative estradiol, might be useful, but stronger evidence is needed. In view of current knowledge, we would recommend a prevention strategy based on a combination of surgical trauma minimization and identification of high-risk cases. Early hysteroscopic diagnosis and lysis possibly represents the best means of secondary prevention and treatment of postoperative intrauterine adhesions.
Collapse
|
58
|
Saravelos SH, Yan J, Rehmani H, Li TC. The prevalence and impact of fibroids and their treatment on the outcome of pregnancy in women with recurrent miscarriage. Hum Reprod 2011; 26:3274-9. [DOI: 10.1093/humrep/der293] [Citation(s) in RCA: 56] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
|
59
|
LÖNNERFORS CELINE, PERSSON JAN. Pregnancy following robot-assisted laparoscopic myomectomy in women with deep intramural myomas. Acta Obstet Gynecol Scand 2011; 90:972-7. [DOI: 10.1111/j.1600-0412.2011.01207.x] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
|
60
|
Kubinova K, Mara M, Horak P, Kuzel D, Dohnalova A. Reproduction after myomectomy: comparison of patients with and without second-look laparoscopy. MINIM INVASIV THER 2011; 21:118-24. [PMID: 21745136 DOI: 10.3109/13645706.2011.573797] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Myomectomy is associated with a high risk of de-novo adhesion formation that may decrease fertility. The purpose of this study was to compare the reproductive outcome of patients after laparoscopic or open myomectomy who underwent second-look (SL) hysteroscopy and laparoscopy including adhesiolysis with patients with no SL intervention. A total of 170 patients underwent open or laparoscopic myomectomy at one centre. All patients were recommended SL. Reproductive results were analyzed in 12 and 24 months intervals following myomectomy. Out of 170 post-myomectomy patients 96 signed informed consent with SL (group A) and 74 withheld (group B). The cumulative pregnancy rate in the 24-months follow-up was: 61.4% and 66.7% (p = 0.535) in group A and group B respectively. Adhesions of adnexa were observed and lysed in the overall of 34.0% of patients at the time of SL. Intrauterine synechiae were present in 1.56% of patients at the SL hysteroscopy. No case of uterine rupture during pregnancy or delivery was recorded. Our results show that the pregnancy rate of patients after myomectomy who underwent SL hysteroscopy and laparoscopy is similar to that of patients with no SL procedure. Adhesiolysis performed during SL does not seem to improve the reproductive outcome of post-myomectomy patients.
Collapse
Affiliation(s)
- Kristyna Kubinova
- Department of Obstetrics and Gynecology Charles University, First Faculty of Medicine and General Faculty Hospital in Prague, Prague, Czech Republic.
| | | | | | | | | |
Collapse
|
61
|
Is another meta-analysis on the effects of intramural fibroids on reproductive outcomes needed? Reprod Biomed Online 2011; 23:2-14. [DOI: 10.1016/j.rbmo.2010.08.006] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2010] [Revised: 08/12/2010] [Accepted: 08/17/2010] [Indexed: 11/19/2022]
|
62
|
Roux I, Faivre E, Trichot C, Donnadieu AC, Fernandez H, Deffieux X. Fertilité après myomectomie par laparotomie pour les femmes de plus de 38 ans. ACTA ACUST UNITED AC 2011; 40:123-9. [DOI: 10.1016/j.jgyn.2010.09.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2010] [Revised: 09/22/2010] [Accepted: 09/22/2010] [Indexed: 10/18/2022]
|
63
|
Wen KC, Sung PL, Lee WL, Li YT, Su WH, Wang PH. Myomectomy for uterine myomas through ultramini-laparotomy. J Obstet Gynaecol Res 2011; 37:383-92. [DOI: 10.1111/j.1447-0756.2010.01359.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
|
64
|
Hackethal A, Westermann A, Tchartchian G, Oehmke F, Tinneberg HR, Muenstedt K, Bojahr B. Laparoscopic myomectomy in patients with uterine myomas associated with infertility. MINIM INVASIV THER 2011; 20:338-45. [PMID: 21247253 DOI: 10.3109/13645706.2010.541922] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Although myomectomy is widely accepted in women of childbearing age who wish to retain their fertility, the extent to which myomas affect fertility and whether their removal improves this remain unclear. This study aimed to elucidate the favourable surgical approach in women with uterine myomas and infertility. This retrospective, follow-up study was carried out in three centres in Germany. Data on women who had undergone myomectomy via laparoscopy, laparotomy or conversion to laparotomy in 2000-04 were collected and analysed. Fertility outcome after myomectomy was assessed by follow-up postal questionnaire in a subgroup of women with myoma-associated infertility. Data on 159 women with otherwise unexplained infertility were included (mean age 35 years (range 17-47), mean number of myomas 2.4 (range 1-8) and mean myoma size 6.1 cm (range 0.5-20)). Women who underwent laparoscopy had fewer complications. 39.6% (63/159) of women completed the questionnaire, which showed that the pregnancy rate after myomectomy was 46% in this group. No uterine rupture occurred. Laparoscopy is associated with fewer postoperative complications and since no preoperative or intraoperative factors seem to influence the fertility outcome in women with uterine myomas, it is the treatment of choice in these patients.
Collapse
Affiliation(s)
- Andreas Hackethal
- Department of Obstetrics and Gynecology , Justus-Liebig-University of Giessen, Germany.
| | | | | | | | | | | | | |
Collapse
|
65
|
|
66
|
Gambadauro P, Magos A. Endoscopic loops for laparoscopic myomectomy. Fertil Steril 2010; 95:e12; author reply e13. [PMID: 21144507 DOI: 10.1016/j.fertnstert.2010.11.042] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2010] [Accepted: 11/12/2010] [Indexed: 11/20/2022]
|
67
|
Chang WC, Chen SY, Huang SC, Chang DY, Chou LY, Sheu BC. Strategy of cervical myomectomy under laparoscopy. Fertil Steril 2010; 94:2710-5. [DOI: 10.1016/j.fertnstert.2010.02.049] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2010] [Revised: 02/23/2010] [Accepted: 02/23/2010] [Indexed: 10/19/2022]
|
68
|
Cakmak H, Taylor HS. Implantation failure: molecular mechanisms and clinical treatment. Hum Reprod Update 2010; 17:242-53. [PMID: 20729534 DOI: 10.1093/humupd/dmq037] [Citation(s) in RCA: 231] [Impact Index Per Article: 16.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Implantation is a complex initial step in the establishment of a successful pregnancy. Although embryo quality is an important determinant of implantation, temporally coordinated differentiation of endometrial cells to attain uterine receptivity and a synchronized dialog between maternal and embryonic tissues are crucial. The exact mechanism of implantation failure is still poorly understood. METHODS This review summarizes the current knowledge about the proposed mechanisms of implantation failure in gynecological diseases, the evaluation of endometrial receptivity and the treatment methods to improve implantation. RESULTS The absence or suppression of molecules essential for endometrial receptivity results in decreased implantation rates in animal models and gynecological diseases, including endometriosis, hydrosalpinx, leiomyoma and polycystic ovarian syndrome. The mechanisms are diverse and include abnormal cytokine and hormonal signaling as well as epigenetic alterations. CONCLUSIONS Optimizing endometrial receptivity in fertility treatment will improve success rates. Evaluation of implantation markers may help to predict pregnancy outcome and detect occult implantation deficiency. Treating the underlying gynecological disease with medical or surgical interventions is the optimal current therapy. Manipulating the expression of key endometrial genes with gene or stem cell-based therapies may some day be used to further improve implantation rates.
Collapse
Affiliation(s)
- Hakan Cakmak
- Department of Obstetrics, Gynecology and Reproductive Sciences, Yale University School of Medicine, 333 Cedar Street, New Haven, CT 06520, USA
| | | |
Collapse
|
69
|
Uterine myomas revisited. Eur J Obstet Gynecol Reprod Biol 2010; 152:119-25. [PMID: 20933150 DOI: 10.1016/j.ejogrb.2010.05.010] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2009] [Revised: 04/17/2010] [Accepted: 05/24/2010] [Indexed: 11/22/2022]
Abstract
The present study was planned to review the pathophysiology of uterine myomas and emphasize the principles of logical management on the basis of literature review and synthesis of the author's experience. The growth of uterine myomas, the most common solid pelvic tumors in women, is related to genetic predisposition, hormonal influences and growth factors. The treatment options include pharmacologic, surgical and radiographic interventions. Most asymptomatic myomas can be followed serially for progressive growth or development of symptoms. The various diagnostic and therapeutic advancements available today permit higher management flexibility with safe options, which must be tailored to the individual patients requirement.
Collapse
|
70
|
Malzoni M, Tinelli R, Cosentino F, Iuzzolino D, Surico D, Reich H. Laparoscopy versus minilaparotomy in women with symptomatic uterine myomas: short-term and fertility results. Fertil Steril 2010; 93:2368-73. [DOI: 10.1016/j.fertnstert.2008.12.127] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2008] [Revised: 12/18/2008] [Accepted: 12/19/2008] [Indexed: 10/21/2022]
|
71
|
Abdominal myomectomy--a safe procedure in an ambulatory setting. Fertil Steril 2010; 94:2277-80. [PMID: 20338561 DOI: 10.1016/j.fertnstert.2010.02.019] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2009] [Revised: 02/04/2010] [Accepted: 02/05/2010] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To evaluate the efficacy and safety of minilaparotomy myomectomy in an ambulatory setting. DESIGN Retrospective, nonrandomized study. SETTING Center for Assisted Reproduction, Bedford, Texas. PATIENT(S) One hundred eighty-nine women desiring fertility with symptomatic uterine leiomyomata. INTERVENTION(S) Minilaparotomy myomectomy in an ambulatory setting. MAIN OUTCOME MEASURE(S) Operative time, blood loss, recovery time, postoperative analgesia, and complications. RESULT(S) The mean diameter of the largest leiomyoma was 4.4 cm (range, 1-14 cm). The mean number and weight of the leiomyomata was 4.9 (range, 1-35) and 109.8 gm (range, 1-1,165 g), respectively. The mean operative time was 73 minutes, and the mean blood loss was 96 mL. On average, patients required 3.5 hours of recovery time. In the recovery room, patients received a mean of 12 mg of morphine/37 mg of meperidine for pain control postoperatively before discharge home. Only one major complication, pulmonary edema related to extubation, occurred. CONCLUSION(S) This study demonstrates that minilaparotomy myomectomy, when performed using a systematic operative technique, can be accomplished in an outpatient setting with minimal blood loss, fast recovery time, and a low complication rate. Postoperatively, patients require minimal analgesia, which permits them to be discharged home the same day. Minilaparotomy myomectomy is a safe, cost-effective treatment of most symptomatic uterine leiomyomata in an ambulatory setting.
Collapse
|
72
|
|
73
|
Liberis V, Tsikouras P, Ammari A, Zografou C, Valentina D, Kafetzis D, Maroulis G. Assessment of the feasibility of bipolar coagulation use to reduce hemorrhage in myomectomy performed by minilaparotomy. MINIM INVASIV THER 2010; 19:75-82. [DOI: 10.3109/13645701003642875] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
|
74
|
Liu G, Zolis L, Kung R, Melchior M, Singh S, Francis Cook E. The Laparoscopic Myomectomy: A Survey of Canadian Gynaecologists. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2010; 32:139-148. [DOI: 10.1016/s1701-2163(16)34428-0] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
|
75
|
Lucot JP, Coutty N, Lions C. Impact sur la fertilité des traitements conservateurs d’un utérus fibromateux : traitements chirurgicaux et non chirurgicaux. IMAGERIE DE LA FEMME 2009. [DOI: 10.1016/j.femme.2009.06.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
|
76
|
|
77
|
Elahi SM, Odejinmi F. Overview of current surgical management of fibroids: ‘Organ-preserving modalities’. J OBSTET GYNAECOL 2009; 28:28-31. [DOI: 10.1080/01443610701814328] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
|
78
|
Kelly BA, Bright P, Mackenzie IZ. Does the surgical approach used for myomectomy influence the morbidity in subsequent pregnancy? J OBSTET GYNAECOL 2009; 28:77-81. [DOI: 10.1080/01443610701811738] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
|
79
|
Cicinelli E, Tinelli R, Colafiglio G, Saliani N. Laparoscopy vs Minilaparotomy in Women with Symptomatic Uterine Myomas: A Prospective Randomized Study. J Minim Invasive Gynecol 2009; 16:422-6. [DOI: 10.1016/j.jmig.2009.03.011] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2008] [Revised: 03/09/2009] [Accepted: 03/13/2009] [Indexed: 11/30/2022]
|
80
|
Abstract
The aim was to examine which is the role of myoma in women infertility. We analyzed 100 patients with infertility that underwent classic abdominal myomesctomy from 2000. to 2003. year. Frequency of conception was 46%. Most patients were over 30-years-old. Conception happened in 80% patients aged 30-39 years. In 69,6% patients with secundar infertility happened conception. Pregnancies occured more often in infertility shorter than 36 months, in front wall myoma and in intramural-subserose or subserose type. In 11 patients with intramural-submucose myomas, uteral cave was opened and only two of them got pregnant. Recidives of myoma happened in 18%, and postoperative adhesions in 29% of pacients. Age, duration of pre-operative infertility and characteristics of myoma did not have statistically significant influence on the conception. Miomectomy is the important method in treatment of infertility, especially if the other possible causes were excluded.
Collapse
|
81
|
The destiny of myomas: should we treat small submucous myomas in women of reproductive age? Fertil Steril 2008; 90:905-10. [DOI: 10.1016/j.fertnstert.2007.09.015] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2007] [Revised: 09/07/2007] [Accepted: 09/07/2007] [Indexed: 11/20/2022]
|
82
|
Mukhopadhaya N, De Silva C, Manyonda IT. Conventional myomectomy. Best Pract Res Clin Obstet Gynaecol 2008; 22:677-705. [DOI: 10.1016/j.bpobgyn.2008.01.012] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
|
83
|
|
84
|
Vimercati A, Scioscia M, Lorusso F, Laera AF, Lamanna G, Coluccia A, Bettocchi S, Selvaggi L, Depalo R. Do uterine fibroids affect IVF outcomes? Reprod Biomed Online 2008; 15:686-91. [PMID: 18062866 DOI: 10.1016/s1472-6483(10)60536-6] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The effect of myomectomy on implantation and pregnancy rates prior to assisted reproduction treatments is controversial. This study was designed to assess clinical outcomes of IVF cycles in women with uterine fibroids. A retrospective single-centre assessment of clinical outcomes of IVF/intracytoplasmic sperm injection (ICSI) treatments in infertile women in a 4-year span was carried out. All patients underwent detailed transvaginal ultrasound and hysteroscopy to precisely identify presence, location and intracavitary growth of uterine fibroids. Cumulative pregnancy, ongoing pregnancy and live birth rates were considered primary outcome measurements. Fifty-one women with fibroids (97 treatment cycles), 63 patients with previous myomectomy (127 cycles), and 106 infertile women who did not demonstrate fibroids anywhere in the uterus (215 cycles) were considered for the analysis. No significant difference was found for pregnancy and live birth rates between groups. Women with fibroids>4 cm required an increased number of cycles to obtain an ongoing pregnancy, compared with the other groups. The data do not support pre-IVF myomectomy in women with small-to-moderate uterine fibroids, regardless of their location. This represents valuable information in the counselling of women with fibroids before reproductive assisted cycles.
Collapse
Affiliation(s)
- Antonella Vimercati
- Department of Gynaecology, Obstetrics and Neonatology, University of Medical Science of Bari, Policlinico of Bari, Piazza Giulio Cesare, 11, 70100 Bari, Italy
| | | | | | | | | | | | | | | | | |
Collapse
|
85
|
Taylor E, Gomel V. The uterus and fertility. Fertil Steril 2007; 89:1-16. [PMID: 18155200 DOI: 10.1016/j.fertnstert.2007.09.069] [Citation(s) in RCA: 213] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2007] [Revised: 09/10/2007] [Accepted: 09/10/2007] [Indexed: 02/06/2023]
Abstract
OBJECTIVE To review the current understanding of the role the uterus plays in embryo implantation and to outline congenital anomalies and acquired diseases that impact normal uterine function. DESIGN The publications related to the embryo implantation, Mullerian anomalies, uterine polyps, uterine synechiae, and myomas were identified through Medline and reviewed. CONCLUSION(S) Congenital anomalies and acquired diseases of the uterus may negatively impact on the complex processes of embryo implantation. Hysteroscopic surgery to correct uterine septa, intrauterine synechiae, and myomas that distort the uterine cavity may benefit women with infertility or recurrent pregnancy loss. The effect of endometrial polyps on fertility is uncertain, but their removal, once identified, is justifiable. Complex congenital anomalies such as unicornuate uterus and uterus didelphys may negatively affect fertility and pregnancy outcome, and surgical treatment may benefit select patients.
Collapse
Affiliation(s)
- Elizabeth Taylor
- Department of Obstetrics and Gynecology, University of British Columbia, BC Women's Hospital and Women's Health Centre,Vancouver, British Columbia, Canada.
| | | |
Collapse
|
86
|
Gavai M, Berkes E, Lazar L, Fekete T, Takacs ZF, Urbancsek J, Papp Z. Factors affecting reproductive outcome following abdominal myomectomy. J Assist Reprod Genet 2007; 24:525-31. [PMID: 18008158 PMCID: PMC3455029 DOI: 10.1007/s10815-007-9135-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2006] [Accepted: 04/12/2007] [Indexed: 11/26/2022] Open
Abstract
PURPOSE Fibroids may cause infertility and recurrent pregnancy loss. Studies have analysed the reproductive results after myomectomy according to the size, location and number of fibroids removed, but data are insufficient about comparison of opening the uterine cavity or not during surgery. MATERIALS AND METHODS Two hundred twenty-nine abdominal myomectomies with the indication of infertility and/or recurrent pregnancy loss were analysed retrospectively. The main purpose was to compare postoperative pregnancy, delivery and miscarriage rates according to either the uterine cavity was opened or not during the surgery. As a secondary outcome postoperative pregnancy rates were assessed by location, size and number of fibroids. RESULTS There was no significant difference in reproductive results according to either the uterine cavity was opened or remained closed. Preoperative location, size and number of fibroids did not influence significantly the postoperative pregnancy rates. CONCLUSION Opening the uterine cavity does not impair postoperative pregnancy rates. Preoperative location, size and number of fibroids do not influence postoperative reproductive results.
Collapse
Affiliation(s)
- Marta Gavai
- Department of Obstetrics and Gynecology, Semmelweis University, 1088-Budapest, Baross Street 27, Budapest, Hungary.
| | | | | | | | | | | | | |
Collapse
|
87
|
Malartic C, Morel O, Akerman G, Tulpin L, Clément D, Barranger E. La myomectomie par cœlioscopie en 2007: état des lieux. ACTA ACUST UNITED AC 2007; 36:567-76. [PMID: 17597308 DOI: 10.1016/j.jgyn.2007.05.003] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2007] [Revised: 04/10/2007] [Accepted: 05/09/2007] [Indexed: 11/30/2022]
Abstract
With fifteen years of development, laparoscopy for myomectomy has proven its advantages. However, this technique remains controversial concerning its feasibility and the quality of uterine scar obtained. Laparoscopic myomectomy (LM) is usually indicated when number of myomas is less than 3 to 4 with a 8 to 9 cm maximal size. Surgical technique is standardized and intervention time becomes acceptable. Risk of conversion ranges between 1 to 3% when technique is realized by trained surgeon. Bleeding is less important compared with laparotomy and immediate postoperative complications are exceptional. Results concerning fertility are positive with more than 50% of infertile patient conceiving after surgery, this rate rising up to 61 to 76% for myomas isolated cause for infertility; these values can be compared with myomectomy realized by laparotomy. Postoperative adhesions seem to be less important after laparoscopy when compared with laparotomy but this point needs to be confirmed. Risk of uterine rupture is estimated between 0 to 1%, but this point needs for larger series evaluation and needs to be compared with pregnancies after laparotomy. Laparoscopic myomectomy is a feasible technique, safe for patients waiting for conception and has proven its interest in case of infertility.
Collapse
Affiliation(s)
- C Malartic
- Service de gynécologie-obstétrique, APHP, hôpital Lariboisière, 2, rue Ambroise-Paré, 75010 Paris, France
| | | | | | | | | | | |
Collapse
|
88
|
El-Shawarby SA, Hassan M, Gangooly S, Chandakas S, Hill N, Erian J. A novel application of the Lap Loop system in day case laparoscopic myomectomy prior to IVF. J OBSTET GYNAECOL 2007; 27:437-8. [PMID: 17654211 DOI: 10.1080/01443610701359605] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
- S A El-Shawarby
- Department of Obstetrics and Gynaecology, Minimal Access Surgery Unit, Princess Royal University Hospital, Orpington, Kent, UK.
| | | | | | | | | | | |
Collapse
|
89
|
Goldberg J, Pereira L. Pregnancy outcomes following treatment for fibroids: uterine fibroid embolization versus laparoscopic myomectomy. Curr Opin Obstet Gynecol 2006; 18:402-6. [PMID: 16794420 DOI: 10.1097/01.gco.0000233934.13684.cb] [Citation(s) in RCA: 67] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
PURPOSE OF REVIEW The management of uterine fibroids in patients requiring treatment who desire future fertility remains controversial. Myomectomy has been the most common operative procedure to improve pregnancy rates and outcomes. Uterine fibroid embolization is an increasingly popular, minimally invasive treatment for fibroids. This review aims to provide critical analysis of available data on pregnancy following myomectomy and uterine artery embolization. RECENT FINDINGS Patients with distorted uterine cavities due to submucosal fibroids of more than 2 cm have higher pregnancy rates following hysteroscopic resection. Pregnancy rates following myomectomy, both via laparoscopy and laparotomy, are in the 50-60% range, with most having good outcomes. Pregnancy rates following uterine artery embolization have not been established. Pregnancies following uterine artery embolization had higher rates of preterm delivery (odds ratio 6.2, 95% confidence interval 1.4-27.7) and malpresentation (odds ratio 4.3, 95% confidence interval 1.0-20.5) than pregnancies following laparoscopic myomectomy. SUMMARY Both myomectomy and uterine artery embolization are safe and effective fibroid treatments, which should be discussed with appropriate candidates. Pregnancy complications, most importantly preterm delivery, spontaneous abortion, abnormal placentation and postpartum hemorrhage, are increased following uterine artery embolization compared to myomectomy. Although most pregnancies following uterine artery embolization have good outcomes, myomectomy should be recommended as the treatment of choice over uterine artery embolization in most patients desiring future fertility.
Collapse
Affiliation(s)
- Jay Goldberg
- Department of Obstetrics, Jefferson Medical College, Philadelphia, Pennsylvania 19107, USA.
| | | |
Collapse
|
90
|
Klatsky PC, Lane DE, Ryan IP, Fujimoto VY. The effect of fibroids without cavity involvement on ART outcomes independent of ovarian age. Hum Reprod 2006; 22:521-6. [PMID: 16997932 DOI: 10.1093/humrep/del370] [Citation(s) in RCA: 61] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND The effect of fibroids that do not distort the endometrial cavity on pregnancy rate (PR) and implantation rate (IR) is controversial. Use of oocyte donor-derived embryos offers an ideal patient population to study the effect of fibroids in patients utilizing assisted reproductive technologies (ARTs). METHODS We conducted a retrospective cohort study of patients undergoing oocyte donor recipient (ODR) IVF cycles at two tertiary care fertility centres. We examined medical records for the presence of non-cavity-distorting fibroids and evaluated subsequent PR and IR. RESULTS Three hundred and sixty-nine patients, 94 with fibroids, underwent oocyte donor recipient transfer cycles with fresh embryos. There was no statistical difference in IR (36 versus 38%) or clinical PR (47 versus 54%) between patients with or without fibroids. Neither the location (subserosal versus intramural) and the presence of multiple myomas nor the size of the myomas affected outcomes. Fibroids were more likely to be present in patients with increasing recipient age. CONCLUSIONS Clinical PR and IR are not affected by the presence of non-cavity-distorting leiomyomata. This evidence does not support myomectomy before ART in patients with asymptomatic fibroids that do not significantly distort the endometrial cavity or cause abnormal uterine bleeding.
Collapse
Affiliation(s)
- P C Klatsky
- Department of Obstetrics/Gynecology, University of California, San Francisco, CA 94143, USA.
| | | | | | | |
Collapse
|
91
|
Abstract
BACKGROUND Fibroids are benign tumours of the uterus occurring in up to 77% of women. Fibroids have been noted to occur more frequently in women with infertility. Retrospective studies have suggested the benefit of surgically removing fibroids to increase the fertility efficacy of both natural conception and assisted conception. There are a variety of methods to surgically remove fibroids including laparotomy, laparoscopy and hysteroscopy. The relative advantages and disadvantages of these modalities in terms of fertility efficacy and side effects are unknown. OBJECTIVES To determine the efficacy and safety of the removal of uterine fibroids in subfertile women by laparotomy, laparoscopy or hysteroscopy when compared with expectant management or each other. The review will include also new surgical approaches as and when they are trialed. SEARCH STRATEGY We searched the Cochrane Menstrual Disorders and Subfertility Review Group Specialised register of controlled trials, MEDLINE (PUBMED) 1985 to 2004, EMBASE (1985 to 2004), CINAHL (1985 to 2004) and National Research Register. SELECTION CRITERIA Randomised controlled trials (RCTs) in which fibroids were removed via surgery for the treatment of infertility DATA COLLECTION AND ANALYSIS Three authors independently assessed trial quality and extracted data. MAIN RESULTS Only one randomized controlled study was included (131 women) and this was probably underpowered. There was no evidence of a difference in outcome in terms of clinical pregnancy rate and live birth rate when fibroids were removed via laparotomy or laparoscopy for infertility. There were some non fertility benefits of removal via laparoscopy including shorter hospital stay, less febrile illness and a smaller drop in pre-operative haemoglobin concentration when compared to laparotomy. There were no randomised controlled studies comparing hysteroscopic removal or no intervention with other surgical modalities. AUTHORS' CONCLUSIONS There is limited evidence to suggest that there is no difference in fertility efficacy outcome if fibroids are removed via laparotomy when compared to laparoscopy. There is no good randomised controlled evidence to support hysteroscopic removal of fibroids compared to other surgical modalities for fertility efficacy.
Collapse
Affiliation(s)
- A Griffiths
- University Hospital of Wales, Department of Obstetrics and Gynaecology, Heath Park, Cardiff, UK.
| | | | | |
Collapse
|
92
|
Khalaf Y, Ross C, El-Toukhy T, Hart R, Seed P, Braude P. The effect of small intramural uterine fibroids on the cumulative outcome of assisted conception. Hum Reprod 2006; 21:2640-4. [PMID: 16790615 DOI: 10.1093/humrep/del218] [Citation(s) in RCA: 60] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND This study aimed to evaluate the effect of small intramural fibroids on the cumulative pregnancy, ongoing pregnancy, live birth and implantation rates after three IVF/ICSI attempts. METHODS The first three treatment cycles of women enrolled for IVF/ICSI over a 12-month period were analysed. Only patients with small (<or=5 cm) intramural fibroids not encroaching upon the endometrial cavity were included in the fibroid group. Cox's hazards regression was used to estimate the hazard ratio (HR) associated with the presence of intramural fibroids. RESULTS During the study period, 322 women without fibroids (control group) and 112 women with fibroids (study group) underwent 606 IVF/ICSI cycles. The pregnancy, ongoing pregnancy and live birth rates in the study group were 23.6, 18.8 and 14.8% compared with 32.9, 28.5 and 24% in the control group, respectively (P<0.05). Cox regression analysis showed that the pregnancy rate at each cycle was reduced by 39% (HR=0.61, 95% CI=0.39-0.95, P=0.029) in the study group compared with the control group. The cumulative ongoing pregnancy rate was reduced by 43% (HR=0.57, 95% CI=0.35-0.91, P=0.018), and the cumulative live birth rate was reduced by 47% (HR=0.53, 95% CI=0.32-0.87, P=0.013) in the study group. After adjusting for confounding variables, the presence of fibroids was found to significantly reduce the ongoing pregnancy rate at each cycle of IVF/ICSI by 40% (HR=0.60, 95% CI=0.36-0.99, P=0.048) and the live birth rate at each cycle by 45% (HR=0.55, 95% CI=0.32-0.95, P=0.03). CONCLUSION Small intramural fibroids are associated with a significant reduction in the cumulative pregnancy, ongoing pregnancy and live birth rates after three IVF/ICSI cycles.
Collapse
Affiliation(s)
- Y Khalaf
- Assisted Conception Unit, Guy's and St. Thomas' Hospital NHS Foundation Trust, Department of Women's Health, King's College London, UK.
| | | | | | | | | | | |
Collapse
|
93
|
Laffita A, Ariosa J, Toledo M. Miomectomía e infertilidad. Estudio de 5 años. CLINICA E INVESTIGACION EN GINECOLOGIA Y OBSTETRICIA 2006. [DOI: 10.1016/s0210-573x(06)74084-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
|
94
|
Alessandri F, Lijoi D, Mistrangelo E, Ferrero S, Ragni N. Randomized study of laparoscopic versus minilaparotomic myomectomy for uterine myomas. J Minim Invasive Gynecol 2006; 13:92-7. [PMID: 16527709 DOI: 10.1016/j.jmig.2005.11.008] [Citation(s) in RCA: 124] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2005] [Revised: 10/31/2005] [Accepted: 11/19/2005] [Indexed: 11/28/2022]
Abstract
STUDY OBJECTIVE To compare the postoperative recovery of patients undergoing laparoscopic and minilaparotomic myomectomy. DESIGN Randomized study (Canadian Task Force classification I). SETTING University hospital. PATIENTS One hundred forty-eight women requiring surgical myomectomy. INTERVENTIONS Myomectomy by minilaparotomy or laparoscopy. MEASUREMENTS AND MAIN RESULTS Operation time was significantly lower in the minilaparotomy group (p < .001). When compared with minilaparotomy, laparoscopy was associated with a lower decline of hemoglobin concentration (p <.001), a reduced length of postoperative ileus (p < .001), and a shorter time to discharge (p <.001). Pain intensity at 6 hours after surgery was significantly lower in the laparoscopy group (p <.001); also, patients who underwent laparoscopy requested analgesics less frequently in the first 48 hours after the operation (p < .001). Patients included in the laparoscopy group were fully recuperated on postoperative day 15 more frequently than those included in the minilaparotomy group (p = .012). No complications were observed in the minilaparotomy group. There were two complications in the laparoscopy group (one laparoconversion caused by difficulties of hemostasis and one acute diffuse peritonitis caused by ileal perforation). Laparoscopic and minilaparotomic myomectomy cost, respectively, 2250 euros and 1975 euros. CONCLUSION When compared with minilaparotomic myomectomy, laparoscopic myomectomy may offer the benefits of lower postoperative analgesic use and faster postoperative recovery.
Collapse
Affiliation(s)
- Franco Alessandri
- Department of Obstetrics and Gynecology, San Martino Hospital and University of Genoa, Largo R. Benzi 10, 16132, Genoa, Italy
| | | | | | | | | |
Collapse
|
95
|
Abstract
As the acceptance of uterine artery embolization as a treatment option for uterine fibroids grows among patients and physicians, it appears that new questions are being asked about the patient selection criteria used for this procedure. In particular, patients with infertility issues or concerns about preserving fertility after fibroid treatment are often being evaluated for uterine artery embolization. This article was prepared to summarize the available literature regarding fertility preservation after both myomectomy and uterine artery embolization and to provide the reader with an algorithm for evaluating these patients and making literature-based treatment decisions.
Collapse
Affiliation(s)
- Louis Domenico
- Department of Radiology, Albany Medical Center, Albany, NY 12208, USA
| | | |
Collapse
|
96
|
|
97
|
Glasser MH. Minilaparotomy myomectomy: A minimally invasive alternative for the large fibroid uterus. J Minim Invasive Gynecol 2005; 12:275-83. [PMID: 15922987 DOI: 10.1016/j.jmig.2005.03.009] [Citation(s) in RCA: 65] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2004] [Accepted: 01/07/2005] [Indexed: 11/21/2022]
Abstract
STUDY OBJECTIVE To assess the efficacy of performing myomectomies through 3- to 6-cm incisions for the removal of myomas up to 14 cm in diameter. DESIGN A retrospective analysis of 139 myomectomies performed at our center from January 1995 through December 2003 (Canadian Task Force classification II-3). SETTING A suburban medical center, part of a large prepaid health maintenance organization. PATIENTS One hundred thirty-nine women. INTERVENTIONS Myomectomies were performed through 3- to 6-cm suprapubic cruciate incisions using atraumatic elastic retractors with or without laparoscopic assist. Myomas were morcellated with a scalpel before being enucleated. The uterus was repaired in a classic three-layered closure in all cases. All procedures were performed in the ambulatory surgery unit of our hospital, which is part of the main operating room. MEASUREMENTS AND MAIN RESULTS The median age of the patients in this series was 30.0 years (range 23-56 years). The median weight of the myomas removed was 275.0 g (range of 30-975 g). One hundred thirty-seven (98.5%) of 139 patients were discharged in 23 hours or less, with 24 patients leaving within 4 hours and 61 within 8 hours. The median length of stay was 6.0 hours, with two patients remaining hospitalized for 48 hours. The median operating time was 110 minutes (range 44-260 min). Estimated blood loss ranged from 50 to 2000 mL, with a median of 300 mL. Three hysterectomies were performed: one as an emergency for hemorrhage and two for recurrent myomas. Three patients developed wound seromas, and one developed a wound infection. CONCLUSIONS Minilaparotomy myomectomy is a safe, effective minimally invasive alternative to laparoscopic myomectomy. Early discharge and return to normal activities is comparable to laparoscopy and is far more cost effective. It affords the ability to palpate the uterus and close the myometrial defect easily with a standard three-layered closure making it particularly suitable for gynecologists with limited laparoscopic suturing skills.
Collapse
Affiliation(s)
- Mark H Glasser
- Department of Obstetrics and Gynecology, Kaiser Permanente Medical Center, San Rafael, California 94903, USA.
| |
Collapse
|
98
|
Pellicano M, Guida M, Bramante S, Acunzo G, Di Spiezio Sardo A, Tommaselli GA, Nappi C. Reproductive outcome after autocrosslinked hyaluronic acid gel application in infertile patients who underwent laparoscopic myomectomy. Fertil Steril 2005; 83:498-500. [PMID: 15705404 DOI: 10.1016/j.fertnstert.2004.09.019] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2004] [Revised: 09/02/2004] [Accepted: 09/02/2004] [Indexed: 02/08/2023]
Abstract
Autocrosslinked hyaluronic acid gel is useful for preventing postsurgical adhesion formation in infertile patients who have undergone laparoscopic myomectomy, and it increases the pregnancy rate more than laparoscopic myomectomy alone. Moreover, pregnancy rate is significantly higher with the use of subserous sutures.
Collapse
Affiliation(s)
- Massimiliano Pellicano
- Department of Obstetrics and Gynecology, University of Naples "Federico II," Naples, Italy.
| | | | | | | | | | | | | |
Collapse
|
99
|
Gambadauro P, Campo V, Campo S. Spontaneous pregnancy following multiple laparoscopic myomectomy in a sterile patient with unilateral ovarian agenesis. Eur J Obstet Gynecol Reprod Biol 2005; 118:270-1. [PMID: 15653222 DOI: 10.1016/j.ejogrb.2004.05.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2004] [Indexed: 11/16/2022]
|
100
|
Abstract
UNLABELLED Uterine fibroids are the most common benign tumors in women, occurring in approximately 20% to 30% of women of reproductive age. They are therefore common in pregnancy. The true incidence of fibroids during pregnancy is, however, unknown, but reported rates vary from as low as 0.1% of all pregnancies to higher rates of 12.5%. It seems that pregnancy has little or no effect on the overall size of fibroids despite the occurrence of red degeneration in early pregnancy. Fibroids, however, affect pregnancy and delivery in several ways, with abdominal pain, miscarriage, malpresentation, and difficult delivery being the most frequent complications. The size, location, and number of fibroids and their relation to the placenta are critical factors. Ultrasound scanning plays a central role in diagnosing and monitoring fibroids during pregnancy and in determining the relative position of the fibroids to the placenta. It is equally useful for detecting heterogeneous echo patterns associated with the appearance of pain in pregnancy. Color flow Doppler scanning differentiates fibroids from myometrial thickening, which may be mistaken for fibroids. Few treatment options are available during pregnancy, but in carefully selected patients, myomectomy has been performed successfully without jeopardizing pregnancy outcome. A successful pregnancy and delivery is common with appropriate surveillance and supportive management. TARGET AUDIENCE Obstetricians & Gynecologists, Family Physicians LEARNING OBJECTIVES After completion of this article, the reader should be able to summarize the influence of pregnancy on fibroids, to explain the influence of fibroids on pregnancy, and to outline the management of fibroids during pregnancy.
Collapse
|