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Futterman ID, Friedmann H, Shpanel-Yukhta O, Minkoff H, Haberman S. Use of natural language processing to uncover racial bias in obstetrical documentation. Clin Imaging 2024; 110:110164. [PMID: 38691911 DOI: 10.1016/j.clinimag.2024.110164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2023] [Revised: 04/09/2024] [Accepted: 04/14/2024] [Indexed: 05/03/2024]
Abstract
Natural Language Processing (NLP), a form of Artificial Intelligence, allows free-text based clinical documentation to be integrated in ways that facilitate data analysis, data interpretation and formation of individualized medical and obstetrical care. In this cross-sectional study, we identified all births during the study period carrying the radiology-confirmed diagnosis of fibroid uterus in pregnancy (defined as size of largest diameter of >5 cm) by using an NLP platform and compared it to non-NLP derived data using ICD10 codes of the same diagnosis. We then compared the two sets of data and stratified documentation gaps by race. Using fibroid uterus in pregnancy as a marker, we found that Black patients were more likely to have the diagnosis entered late into the patient's chart or had missing documentation of the diagnosis. With appropriate algorithm definitions, cross referencing and thorough validation steps, NLP can contribute to identifying areas of documentation gaps and improve quality of care.
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Affiliation(s)
- Itamar D Futterman
- Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, Maimonides Medical Center, Brooklyn, NY, United States of America.
| | - Hila Friedmann
- Gynisus Inc., Santa Monica, CA, United States of America
| | | | - Howard Minkoff
- Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, Maimonides Medical Center, Brooklyn, NY, United States of America
| | - Shoshana Haberman
- Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, Maimonides Medical Center, Brooklyn, NY, United States of America
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2
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Hase E, Iervolino L, Antico H, Bozzini N, Francisco R. Giant uterine tumor and miscarriage: how to proceed? Braz J Med Biol Res 2024; 57:e13549. [PMID: 38716986 PMCID: PMC11085029 DOI: 10.1590/1414-431x2024e13549] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2023] [Accepted: 03/22/2024] [Indexed: 05/12/2024] Open
Abstract
Expanding uterine masses can be the cause of pregnancy loss and add technical difficulties to uterus evacuation due to the intense anatomical distortion of the endocervical canal and uterine cavity. The literature is scarce in the peculiarities of the management of missed abortions in uterus with important distorted anatomies. We report a case of a primigravida patient who presented a rapid and expressive increase of abdominal volume due to a giant uterine mass, evolving to miscarriage. Ultrasound can be a useful tool, allowing visualization of the endocervical path and uterine cavity, helping to perform uterine evacuation in the presence of anatomical distortion without compromising the reproductive future. To the best of our knowledge, no such case has been previously reported.
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Affiliation(s)
- E.A. Hase
- Departamento de Obstetrícia e Ginecologia, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brasil
| | - L.L. Iervolino
- Departamento de Obstetrícia e Ginecologia, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brasil
| | - H.A. Antico
- Departamento de Obstetrícia e Ginecologia, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brasil
| | - N. Bozzini
- Departamento de Obstetrícia e Ginecologia, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brasil
| | - R.P.V. Francisco
- Departamento de Obstetrícia e Ginecologia, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brasil
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3
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Delgado RG, Rodríguez RG, Flores JS, González JP, Cárdenes IO, González LH, Martínez AM. Leiomyoma With Cystic Degeneration in a Pregnancy: Percutaneous Drainage as an Alternative to Myomectomy. J Minim Invasive Gynecol 2024; 31:263-264. [PMID: 38199519 DOI: 10.1016/j.jmig.2024.01.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2023] [Revised: 12/26/2023] [Accepted: 01/03/2024] [Indexed: 01/12/2024]
Affiliation(s)
- Raquel García Delgado
- Department of Obstetrics and Gynecology (Drs. Delgado, Rodríguez, Cárdenes, and Martínez), Hospital Universitario Materno Infantil de Canarias, Las Palmas de Gran Canaria, Spain.
| | - Raquel García Rodríguez
- Department of Obstetrics and Gynecology (Drs. Delgado, Rodríguez, Cárdenes, and Martínez), Hospital Universitario Materno Infantil de Canarias, Las Palmas de Gran Canaria, Spain
| | - Juan Sánchez Flores
- Department of Radiology, Hospital Universitario Insular de Gran Canaria, Las Palmas de Gran Canaria, Spain (Dr. Flores)
| | - Julio Pérez González
- Department of Radiology (Dr. González), Hospital Universitario Materno Infantil de Canarias, Las Palmas de Gran Canaria, Spain
| | - Ismael Ortega Cárdenes
- Department of Obstetrics and Gynecology (Drs. Delgado, Rodríguez, Cárdenes, and Martínez), Hospital Universitario Materno Infantil de Canarias, Las Palmas de Gran Canaria, Spain
| | - Lourdes Hernández González
- Department of Anesthesiology (Dr. González), Hospital Universitario Materno Infantil de Canarias, Las Palmas de Gran Canaria, Spain
| | - Alicia Martín Martínez
- Department of Obstetrics and Gynecology (Drs. Delgado, Rodríguez, Cárdenes, and Martínez), Hospital Universitario Materno Infantil de Canarias, Las Palmas de Gran Canaria, Spain
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4
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Hui M, Sibai B, Montealegre A, Leon MG. Uterine Leiomyomata as a Cause of Abdominal Compartment Syndrome in the Postpartum Period. AJP Rep 2024; 14:e74-e79. [PMID: 38370330 PMCID: PMC10874694 DOI: 10.1055/a-2164-8100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2023] [Accepted: 08/17/2023] [Indexed: 02/20/2024] Open
Abstract
Uterine leiomyomas are common benign smooth muscle tumors that often occur during the reproductive years. Although many cases may not result in significant complications, negative pregnancy outcomes have been associated with the size and location of the fibroids. Degeneration of fibroids can occur as early as the late first trimester when they undergo significant volumetric growth, contributing to pain during pregnancy. While myomectomy is typically avoided during pregnancy, conservative management with anti-inflammatory medications may be effective. Surgical removal or preterm delivery may be necessary if symptoms persist. Abdominal compartment syndrome (ACS) is a rare condition characterized by sustained elevated intra-abdominal pressure leading to organ failure. Although ACS resulting from large-volume leiomyomas in the postpartum period has not been previously described, we present a case of a 25-year-old patient with massive uterine fibroids who required indicated preterm delivery via primary cesarean section at 25 weeks gestation. Her postpartum course was complicated by ACS, requiring emergent surgical decompression. When a large fibroid burden is present during pregnancy or in the postpartum period, ACS should be considered in the differential diagnosis. Early diagnosis and timely surgical decompression are necessary to prevent organ dysfunction and worsening maternal outcomes.
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Affiliation(s)
- Mason Hui
- Department of Obstetrics, Gynecology, and Reproductive Sciences, McGovern Medical School at The University of Texas Health Science Center at Houston, Houston, Texas
| | - Baha Sibai
- Department of Obstetrics, Gynecology, and Reproductive Sciences, McGovern Medical School at The University of Texas Health Science Center at Houston, Houston, Texas
| | - Alvaro Montealegre
- Department of Obstetrics, Gynecology, and Reproductive Sciences, McGovern Medical School at The University of Texas Health Science Center at Houston, Houston, Texas
| | - Mateo G. Leon
- Department of Obstetrics, Gynecology, and Reproductive Sciences, McGovern Medical School at The University of Texas Health Science Center at Houston, Houston, Texas
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5
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Wang Q, Lin J, Dai Y. Outcomes of cesarean myomectomy via trans-endometrial approach in women with single intramural fibroid in the posterior uterine wall. J Matern Fetal Neonatal Med 2023; 36:2232655. [PMID: 37433647 DOI: 10.1080/14767058.2023.2232655] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Revised: 06/12/2023] [Accepted: 06/29/2023] [Indexed: 07/13/2023]
Abstract
OBJECTIVE To evaluate the feasibility and effectiveness of cesarean myomectomy (CM) via trans-endometrial approach in pregnant women with single intramural fibroid in the posterior uterine wall. METHODS Ninety-eight patients with single intramural fibroids in the posterior uterine wall who underwent CM were divided into two groups depending on surgical style. The study group consisted of 50 patients who underwent trans-endometrial myomectomy (EM), whereas the control group included 48 patients who had trans-serosal myomectomy (SM). Patients' demographic data, intraoperative and postoperative outcomes were analyzed retrospectively. RESULTS No significant differences were found in the baseline characteristics of the two groups, including demographic data, size, location of fibroids, comorbidities, and indications for cesarean section. During the perioperative period, we did not observe significant differences between the two groups in terms of intraoperative hemorrhage, blood transfusion rate, postoperative fever incidence and postoperative hospitalization (all p > .05). It's worth noting that the time of operation and postoperative ventilation in the EM group was shorter than that in the SM group (p < .05). More importantly, estimated blood loss and postoperative hemoglobin decline were less in the EM group than in the SM group (p < .05). CONCLUSION EM seems to be a viable approach to CM for the treatment of single intramural fibroids in the posterior wall, with the potential advantages of short operative time, low intraoperative bleeding, and low risk of pelvic adhesions.
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Affiliation(s)
- Qi Wang
- Fujian Key Laboratory of Women and Children's Critical Diseases Research, Department of Obstetrics and Gynecology, Fujian Maternity and Child Health Hospital, Affiliated Hospital of Fujian Medical University, Fuzhou, P.R. China
| | - Jinxiao Lin
- Fujian Key Laboratory of Women and Children's Critical Diseases Research, Department of Obstetrics and Gynecology, Fujian Maternity and Child Health Hospital, Affiliated Hospital of Fujian Medical University, Fuzhou, P.R. China
| | - Yan Dai
- Fujian Key Laboratory of Women and Children's Critical Diseases Research, Department of Obstetrics and Gynecology, Fujian Maternity and Child Health Hospital, Affiliated Hospital of Fujian Medical University, Fuzhou, P.R. China
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6
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Tan X, Peng X, Fan Y. Cesarean myomectomy of an oversized myoma via a normal incision. Asian J Surg 2023; 46:5799-5800. [PMID: 37659932 DOI: 10.1016/j.asjsur.2023.08.195] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Accepted: 08/24/2023] [Indexed: 09/04/2023] Open
Affiliation(s)
- Xi Tan
- Department of Gynecology and Obstetrics, West China Second Hospital, Sichuan University, Chengdu, People's Republic of China; Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Ministry of Education, Chengdu, People's Republic of China
| | - Xue Peng
- Department of Gynecology and Obstetrics, West China Second Hospital, Sichuan University, Chengdu, People's Republic of China; Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Ministry of Education, Chengdu, People's Republic of China.
| | - Yu Fan
- Department of Gynecology and Obstetrics, West China Second Hospital, Sichuan University, Chengdu, People's Republic of China; Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Ministry of Education, Chengdu, People's Republic of China.
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7
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Almusaylim MS, Darwish FA, Alahmad FA, Alsaleh MA, Almohammedsaleh MM. Large Submucosal Uterine Leiomyoma Prolapse Into the Vagina After Complicating a Pregnancy: A Case Report. Cureus 2023; 15:e49116. [PMID: 38125246 PMCID: PMC10732330 DOI: 10.7759/cureus.49116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/20/2023] [Indexed: 12/23/2023] Open
Abstract
Uterine leiomyomas are the most common pelvic neoplasm in females. They are non-cancerous monoclonal tumors that develop from the fibroblasts and smooth muscle cells of the myometrium. They can develop in females of reproductive age and post-menopausal as well. When symptomatic, they frequently manifest as abnormal uterine bleeding and/or pelvic pain or pressure. Reproductive effects are also possible in fibroids such as infertility and poor pregnancy outcomes. In this report, we present a case of a 39-year-old woman, G9P4A4, GA 16 weeks who came to the ER with an incomplete abortion at home after which she had large multiple uterine submucosal fibroids prolapsing into the vagina. On ultrasound, the placenta was still inside, and a large submucosal anterior uterine fibroid and a posterior uterine fibroid were found with sizes 10x10 cm and 2x3, respectively. Evacuation and curettage (E&C) could not be completed because fibroids were obstructing and limiting the access. The patient was managed medically and then discharged, after which she came back with prolapsing uterine fibroids and part of the placenta. In the end, she was managed by hysteroscopic myomectomy.
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Affiliation(s)
- Moayad S Almusaylim
- Obstetrics and Gynaecology, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, SAU
| | - Faten A Darwish
- Obstetrics and Gynaecology, King Faisal General Hospital, Al-Ahsa, SAU
| | - Fatimah A Alahmad
- Obstetrics and Gynaecology, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, SAU
| | - Mustafa A Alsaleh
- General Surgery, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, SAU
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8
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Hartman R, Colón-Mercado O, Johnson V, Baron J, Davis L. Uterine Rupture Secondary to Pyomyoma, Leading to Intra-Abdominal Abscesses following an Uncomplicated Vaginal Delivery. Case Rep Obstet Gynecol 2023; 2023:3306687. [PMID: 37829000 PMCID: PMC10567210 DOI: 10.1155/2023/3306687] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Revised: 08/31/2023] [Accepted: 09/07/2023] [Indexed: 10/14/2023] Open
Abstract
Background Pyomyomas are an infrequent complication of uterine fibroids and, in extremely rare cases, the cause of spontaneous uterine rupture. A few documented cases were managed conservatively with oral antibiotics and CT-guided drainage or myomectomy with fertility preserved. However, treatment more frequently involves IV antibiotics and a hysterectomy. Case Description. A 31-year-old G2P0111 PPD 7 presented with intra-abdominal abscesses of unknown source. She was treated with broad-spectrum antibiotics, image-guided percutaneous (IR) drainage of the largest abscess, and surgical exploration with debridement. During surgery, she was diagnosed with spontaneous uterine rupture. The uterine defect was successfully repaired, and she was able to be successfully managed with fertility-sparing treatment. The patient ultimately did not require a hysterectomy. The final pathology was consistent with pyomyoma. Conclusion In a majority of cases, pyomyoma treatment requires a hysterectomy, and fertility is unable to be preserved. However, conservative management with IV antibiotics, IR drainage, and surgical debridement could be a fertility-preserving approach to the treatment of pyomyomas.
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Affiliation(s)
- Rachel Hartman
- HCA Healthcare/USF Morsani College of Medicine GME Program, Brandon Regional Hospital, Brandon, FL, USA
| | - Olga Colón-Mercado
- HCA Healthcare/USF Morsani College of Medicine GME Program, Brandon Regional Hospital, Brandon, FL, USA
| | - Valario Johnson
- HCA Healthcare/USF Morsani College of Medicine GME Program, Brandon Regional Hospital, Brandon, FL, USA
| | - James Baron
- HCA Healthcare/USF Morsani College of Medicine GME Program, Brandon Regional Hospital, Brandon, FL, USA
| | - Lauren Davis
- HCA Healthcare/USF Morsani College of Medicine GME Program, Brandon Regional Hospital, Brandon, FL, USA
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9
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Yaghoubian YC, Prasannan L, Alvarez A, Gerber RP, Galagedera N, Blitz MJ. Fibroid size and number and risk of postpartum hemorrhage. Am J Obstet Gynecol 2023; 229:344-345. [PMID: 37172925 DOI: 10.1016/j.ajog.2023.05.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Revised: 05/04/2023] [Accepted: 05/04/2023] [Indexed: 05/15/2023]
Affiliation(s)
- Yasaman C Yaghoubian
- Department of Obstetrics and Gynecology, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, 23 Schenck Ave., APT 3AB Great neck, Hempstead, NY 11021.
| | - Lakha Prasannan
- Department of Obstetrics and Gynecology, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY; Department of Obstetrics and Gynecology, New York University Langone Hospital-Long Island, New York University Long Island School of Medicine, Mineola, NY
| | - Alejandro Alvarez
- Biostatistics Unit, Office of Academic Affairs, Northwell Health, New Hyde Park, NY
| | - Rachel P Gerber
- Department of Obstetrics and Gynecology, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY
| | - Nirupa Galagedera
- Department of Obstetrics and Gynecology, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY
| | - Matthew J Blitz
- Department of Obstetrics and Gynecology, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY; Institute of Health Systems Science, Feinstein Institutes for Medical Research, Northwell Health, Manhasset, NY
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10
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Farkas AH, Abumusa H, Rossiter B. Structural Gynecological Disease: Fibroids, Endometriosis, Ovarian Cysts. Med Clin North Am 2023; 107:317-328. [PMID: 36759100 DOI: 10.1016/j.mcna.2022.10.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Fibroids, endometriosis, and ovarian cysts are common conditions. Fibroids can be asymptomatic or present with heavy menstrual bleeding, pelvic pressure, and pain. Endometriosis is a common cause of cyclical pelvic pain. Ovarian cysts are generally diagnosed incidentally. Transvaginal ultrasound is the performed imaging modality for all structural gynecological disease. Symptomatic management is recommended for each condition. Fibroids can be managed medically or surgically depending on the patient's symptoms and desire for future fertility. Nonsteroidal anti-inflammatory drugs are the first-line therapy for endometriosis followed by oral contraceptives and surgical management. Ovarian cysts can be managed expectantly.
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Affiliation(s)
- Amy H Farkas
- Division of General Internal Medicine, Medical College of Wisconsin, Milwaukee VA Medical Center, 5000 West National Avenue, Milwaukee, WI 53295, USA.
| | - Hannah Abumusa
- Division of General Internal Medicine, University of Pittsburgh School of Medicine, UPMC VAPT, VA Pittsburgh Healthcare System, 4100 Allequippa Street, Pittsburgh, PA 15240, USA
| | - Brianna Rossiter
- Division of General Internal Medicine, University of Pittsburgh School of Medicine, UPMC VAPT, VA Pittsburgh Healthcare System, 4100 Allequippa Street, Pittsburgh, PA 15240, USA
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Cersonsky TEK, Lord M, Pinar H. Intrauterine Fetal Demise Associated with Vascular Malperfusion and Multiple Uterine Leiomyomata: A Report of Two Cases. Fetal Pediatr Pathol 2023; 42:83-92. [PMID: 35243966 DOI: 10.1080/15513815.2022.2047847] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Uterine leiomyomata have been loosely associated with intrauterine fetal demise (IUFD), largely attributed to fetal growth restriction from cavitary distortion. We present two cases of IUFD in patients with non-distorting leiomyomata and pathologic placental findings of maternal vascular malperfusion (MVM) and fetal vascular malperfusion (FVM). CASE REPORT Case 1 details a 28w3d IUFD associated with large leiomyomata (largest 11.9 × 7.6 × 9.7 cm), post-partum deep vein thrombosis, and severe pre-eclampsia histologic features. Case 2 details a 25w2d IUFD associated with smaller leiomyomata (largest 3.1 × 3.0 × 3.3 cm). Both placentas demonstrated MVM, including parenchymal thrombi and accelerated villous maturity, and FVM, including avascular stem villi. DISCUSSION As the placentas in both cases demonstrated findings consistent with altered placental perfusion, we posit that leiomyomata in these cases may have been associated with both maternal and fetal vascular malperfusion, ultimately contributing to fetal demise.
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Affiliation(s)
| | - Megan Lord
- Division of Maternal-Fetal Medicine, Women and Infants Hospital of Rhode Island, Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Halit Pinar
- Department of Pathology, Women and Infants Hospital of Rhode Island, Warren Alpert Medical School of Brown University, Providence, RI, USA
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12
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Kim YR, Na ED, Jung JE, Moon JH, Lee JY. Clinical features at the time of non-hysteroscopic myomectomy before pregnancy, which affect adverse pregnancy outcomes: a retrospective cohort study. BMC Pregnancy Childbirth 2022; 22:896. [PMID: 36463110 PMCID: PMC9719619 DOI: 10.1186/s12884-022-05240-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Accepted: 11/24/2022] [Indexed: 12/07/2022] Open
Abstract
BACKGROUND To investigate the association of clinical characteristics at the time of non-hysteroscopic myomectomy before pregnancy and adverse obstetric outcomes in the next pregnancy. METHODS In this retrospective cohort study, we identified 248 women who underwent abdominal or laparoscopic myomectomy for intramural (IM) and/or subserosal (SS) uterine myomas in Bundang CHA Medical Center before pregnancy and delivered at the same hospital between 2010 and 2020. The association between clinical characteristics at the time of myomectomy and subsequent obstetric outcomes was analyzed using the Chi-square test, the Student t-test or one-way ANOVA, and multivariable analysis. RESULTS There was one case of uterine rupture. The gestational age at delivery was 37.7 ± 2.4 weeks. There were 2 (0.8%) cases of fetal loss before 23 weeks, but there were no cases of perinatal death. The risk of transfusion during or after delivery was higher in the group in which multiple myomas were removed compared to the group in which only one was removed (aOR = 2.41, 95% CI [1.20-4.86], p = 0.014). The risk of neonatal composite morbidity was higher in the group in which myomas including the IM type were removed, than in the group in which only SS myomas were removed (aOR = 14.29, 95% CI [1.82-99.57], p = 0.012). Although not statistically significant, the group in which the sum of the diameters of the three largest myomas was greater than 15 cm showed a higher frequency of preterm birth (19.3% vs. 10.1%, p = 0.001) and lower birth weight (2901 ± 625 g vs. 3063 ± 576 g, p = 0.001) compared to the group with diameters less than 15 cm. Placenta accreta/increta (7.9% vs. 3.8%, p = 0.043) and lower placental weight (646 ± 170 g vs. 750 ± 232 g, p = 0.034) were more common in patients with an interval between myomectomy and pregnancy of less than 12 months compared to more than 12 months. CONCLUSIONS To our knowledge, this is the first study to investigate the association between clinical features at the time of myomectomy before pregnancy and various adverse obstetric and perinatal outcomes. If the removed myomas are multiple, IM, large, or the interval between myomectomy and pregnancy is short, the risk of obstetric and neonatal complications may increase.
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Affiliation(s)
- Young Ran Kim
- Department of Obstetrics and Gynecology, CHA Bundang Medical Center, CHA University School of Medicine, 13496, Seongnam, South Korea
| | - Eun Duc Na
- Department of Obstetrics and Gynecology, CHA Bundang Medical Center, CHA University School of Medicine, 13496, Seongnam, South Korea
| | - Jae Eun Jung
- Department of Obstetrics and Gynecology, CHA Bundang Medical Center, CHA University School of Medicine, 13496, Seongnam, South Korea
| | - Ji Hyun Moon
- Department of Obstetrics and Gynecology, CHA Bundang Medical Center, CHA University School of Medicine, 13496, Seongnam, South Korea
| | - Ji Yeon Lee
- Department of Obstetrics and Gynecology, CHA Bundang Medical Center, CHA University School of Medicine, 13496, Seongnam, South Korea.
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13
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Choudhary N, Verma A, Gurjar A, Agarwal S, Jain B, Chaturvedi A. Unusual case of coexisting large intramyometrial anterior uterine wall leiomyoma with term pregnancy. Med J Armed Forces India 2022; 78:S262-S265. [PMID: 36147422 PMCID: PMC9485752 DOI: 10.1016/j.mjafi.2019.09.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2019] [Accepted: 09/03/2019] [Indexed: 10/25/2022] Open
Abstract
Leiomyomas are the most common benign smooth muscle tumors of the uterus. The incidence during pregnancy ranges between 1.6 to 10%. The management of fibroids encountered during caesarean section poses a therapeutic dilemma. We present a case of giant anterior wall leiomyoma complicating term pregnancy which posed a great surgical challenge. We didn't go for myomectomy in the same setting because the patient was primigravida and leiomyoma occupied complete anterior wall of the uterus, an attempt of myomectomy could result in profuse uncontrollable bleeding.
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Affiliation(s)
- Neha Choudhary
- Senior Resident (Obstetrics and Gynecology), SMS Medical College, Jaipur, India
| | - Asha Verma
- Professor (Obstetrics and Gynecology), SMS Medical College, Jaipur, India
| | - Anil Gurjar
- Assistant Professor (Obstetrics and Gynecology), SMS Medical College, Jaipur, India
| | - Shimona Agarwal
- Senior Resident (Obstetrics and Gynecology), SMS Medical College, Jaipur, India
| | - Baishali Jain
- Junior Resident (Obstetrics and Gynecology), SMS Medical College, Jaipur, India
| | - Amrita Chaturvedi
- Junior Resident (Obstetrics and Gynecology), SMS Medical College, Jaipur, India
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14
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Farland LV, Stern JE, Liu CL, Cabral HJ, Coddington CC, Diop H, Dukhovny D, Hwang S, Missmer SA. Pregnancy outcomes among women with endometriosis and fibroids: registry linkage study in Massachusetts. Am J Obstet Gynecol 2022; 226:829.e1-829.e14. [PMID: 35108504 DOI: 10.1016/j.ajog.2021.12.268] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Revised: 12/21/2021] [Accepted: 12/29/2021] [Indexed: 12/18/2022]
Abstract
BACKGROUND Endometriosis and uterine fibroids are common gynecologic conditions associated with a greater risk for infertility. Previous research has suggested that these conditions are associated with adverse pregnancy outcomes, potentially because of increased utilization of fertility treatments. OBJECTIVE Our objective was to investigate whether women with a history of endometriosis or fibroids had a greater risk for adverse pregnancy outcomes and whether this risk varied by infertility history and fertility treatment utilization. STUDY DESIGN Deliveries (2013-2017) recorded in Massachusetts' vital records were linked to assisted reproductive technology data, hospital stays, and all-payer claims database. We identified endometriosis and fibroids diagnoses via the all-payer claims database before index delivery. Adjusted relative risks for pregnancy complications were modeled using generalized estimating equations with a log link and Poisson distribution. The influence of subfertility or infertility and assisted reproductive technology was also investigated. RESULTS Among 91,825 deliveries, 1560 women had endometriosis and 4212 had fibroids. Approximately 30% of women with endometriosis and 26% of women with fibroids experienced subfertility or infertility without utilizing assisted reproductive technology, and 34% of women with endometriosis and 21% of women with fibroids utilized assisted reproductive technology for the index delivery. Women with a history of endometriosis or fibroids were at a greater risk for pregnancy-induced hypertension, preeclampsia, or eclampsia (endometriosis relative risk, 1.17; fibroids relative risk, 1.08), placental abnormalities (endometriosis relative risk, 1.65; fibroids relative risk, 1.38), and cesarean delivery (endometriosis relative risk, 1.22; fibroids relative risk, 1.17) than women with no history of those conditions. Neonates born to women with a history of endometriosis or fibroids were also at a greater risk for preterm birth (endometriosis relative risk, 1.24; fibroids relative risk, 1.17). Associations between fibroids and low birthweight varied by fertility status or assisted reproductive technology (P homogeneity=.01) and were stronger among noninfertile women. CONCLUSION Endometriosis or fibroids increased the risk for adverse pregnancy outcomes, possibly warranting differential screening or treatment.
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15
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Pandit U, Singh M, Ranjan R. Assessment of Maternal and Fetal Outcomes in Pregnancy Complicated by Fibroid Uterus. Cureus 2022; 14:e22052. [PMID: 35295349 PMCID: PMC8916919 DOI: 10.7759/cureus.22052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/09/2022] [Indexed: 12/03/2022] Open
Abstract
Background The study aims to assess maternal and fetal outcomes in pregnancy complicated by a fibroid uterus. Materials and methods Sixty-four adult women patients with fibroids in age range of 25-45 years were selected. Fetal and maternal outcomes were recorded. Results Thirty-four patients were in the age group of 25-35 years, and 50 were aged 35-45 years of age. Primigravida was seen in 52 and multigravida in 32. The common types were intramural in 40, submucosal in 16, pedunculated in seven, and subserosal in 21 cases. Size >5 cm was seen in 38 and 2 cm-5 cm in 46 patients. Common symptoms were preterm labor pain in 50, abdominal pain in 12, and urinary tract infection (UTI) in 22 cases. The common sites were the anterior wall fibroid in 42, posterior wall in 22, and lateral wall in 20 cases. Complications reported in our study were premature rupture of membranes (PROMs) in 12, threatened preterm in 11, associated infertility in five, intrauterine growth retardation (IUGR) in two, malpresentation in seven, postpartum hemorrhage (PPH) in four, preterm labor in six, and abruption in eight cases. The difference was observed to be significant (P<0.05). Conclusion Common complications were PROM, threatened preterm, associated infertility, IUGR, malpresentation, PPH, preterm labor, and abruption.
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16
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Sundermann AC, Aldridge TD, Hartmann KE, Jones SH, Torstenson ES, Edwards DRV. Uterine fibroids and risk of preterm birth by clinical subtypes: a prospective cohort study. BMC Pregnancy Childbirth 2021; 21:560. [PMID: 34404387 PMCID: PMC8369624 DOI: 10.1186/s12884-021-03968-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Accepted: 06/09/2021] [Indexed: 11/17/2022] Open
Abstract
Background Fibroids are present in approximately one in ten pregnancies and are inconsistently linked with preterm birth. We sought to determine the association between fibroids and preterm birth in a prospective cohort with standardized research ultrasounds for characterizing fibroids in early pregnancy while accounting for the clinical paths that precede preterm birth. Methods Participants who were pregnant or planning a pregnancy were recruited from communities in three states between 2000 and 2012. Members of this prospective cohort had a research ultrasound in the first trimester to establish pregnancy dating and to record detailed information about the presence, size, number, and location of fibroids. Baseline information from time of enrollment and a detailed first trimester interview contributed key information about candidate confounders. Birth outcomes, including clinical classification of type of preterm birth (preterm labor, preterm premature rupture of membranes, and medically indicated preterm birth) were cross-validated from participant report, labor and delivery records, and birth certificate data. Results Among 4,622 women with singleton pregnancies, 475 had at least one fibroid (10.3%) and 352 pregnancies resulted in preterm birth (7.6%). Prevalence of fibroids was similar for women with preterm and term births (10.2% vs. 10.3%). Fibroids were not associated with increased risk of preterm birth after taking into account confounding (risk ratio adjusted for race/ethnicity and maternal age, 0.88; 95% confidence interval, 0.62–1.24) nor any clinical subtype of preterm birth. No fibroid characteristic or combination of characteristics was associated with risk. Conclusions If fibroids increase risk of preterm birth, the effect is substantially smaller than previous estimates. Given lack of effect in a large population of women from the general population, rather than higher risk academic tertiary populations previously most studied, we encourage a reconsideration of the clinical impression that presence of fibroids is a major risk factor for preterm birth.
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Affiliation(s)
- Alexandra C Sundermann
- Vanderbilt Epidemiology Center, Institute for Medicine and Public Health, Vanderbilt University Medical Center, 2525 West End Avenue, Nashville, TN, 37203, USA.,Women's Health Research at Vanderbilt, Vanderbilt University Medical Center, 2525 West End Avenue, Nashville, TN, 37203, USA
| | - Tiara D Aldridge
- Division of Quantitative Sciences, Department of Obstetrics and Gynecology, Vanderbilt University Medical Center, 1211 Medical Center Drive, Nashville, TN, 37212, USA
| | - Katherine E Hartmann
- Vanderbilt Epidemiology Center, Institute for Medicine and Public Health, Vanderbilt University Medical Center, 2525 West End Avenue, Nashville, TN, 37203, USA. .,Women's Health Research at Vanderbilt, Vanderbilt University Medical Center, 2525 West End Avenue, Nashville, TN, 37203, USA. .,Division of Quantitative Sciences, Department of Obstetrics and Gynecology, Vanderbilt University Medical Center, 1211 Medical Center Drive, Nashville, TN, 37212, USA.
| | - Sarah H Jones
- Vanderbilt Epidemiology Center, Institute for Medicine and Public Health, Vanderbilt University Medical Center, 2525 West End Avenue, Nashville, TN, 37203, USA.,Women's Health Research at Vanderbilt, Vanderbilt University Medical Center, 2525 West End Avenue, Nashville, TN, 37203, USA
| | - Eric S Torstenson
- Vanderbilt Epidemiology Center, Institute for Medicine and Public Health, Vanderbilt University Medical Center, 2525 West End Avenue, Nashville, TN, 37203, USA
| | - Digna R Velez Edwards
- Vanderbilt Epidemiology Center, Institute for Medicine and Public Health, Vanderbilt University Medical Center, 2525 West End Avenue, Nashville, TN, 37203, USA.,Women's Health Research at Vanderbilt, Vanderbilt University Medical Center, 2525 West End Avenue, Nashville, TN, 37203, USA.,Division of Quantitative Sciences, Department of Obstetrics and Gynecology, Vanderbilt University Medical Center, 1211 Medical Center Drive, Nashville, TN, 37212, USA
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17
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Cross CI, Driggers PH, McCarthy BE, Diab M, Brennan J, Segars JH. A-kinase anchoring protein 13 interacts with the vitamin D receptor to alter vitamin D-dependent gene activation in uterine leiomyoma cells. F&S SCIENCE 2021; 2:303-314. [PMID: 35560280 DOI: 10.1016/j.xfss.2021.04.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Accepted: 04/08/2021] [Indexed: 06/15/2023]
Abstract
OBJECTIVE To determine if A-kinase anchoring protein 13 (AKAP13) interacts with the vitamin D receptor (VDR) to alter vitamin D-dependent signaling in fibroid cells. Uterine leiomyomas (fibroids) are characterized by a fibrotic extracellular matrix and are associated with vitamin D deficiency. Treatment with vitamin D (1,25-dihydroxyvitamin D3) reduces fibroid growth and extracellular matrix gene expression. A-kinase anchoring protein 13 is overexpressed in fibroids and interacts with nuclear hormone receptors, but it is not known whether AKAP13 may interact with the VDR to affect vitamin D signaling in fibroids. DESIGN Laboratory studies. SETTING Translational science laboratory. INTERVENTION(S) Human immortalized fibroid or myometrial cells were treated with 1,25-hydroxyvitamin D3 (1,25(OH)2D3) and transfected using expression constructs for AKAP13 or AKAP13 mutants, RhoQL, C3 transferase, or small interfering ribonucleic acids (RNAs). MAIN OUTCOME MEASURE(S) Messenger ribonucleic acid (mRNA) levels of AKAP13, fibromodulin, and versican as measured by quantitative real-time polymerase chain reaction. Glutathione S-transferase-binding assays. Vitamin D-dependent gene activation as measured by luciferase assays. RESULT(S) 1,25(OH)2D3 resulted in a significant reduction in mRNA levels encoding AKAP13, versican, and fibromodulin. Small interfering RNA silencing of AKAP13 decreased both fibromodulin and versican mRNA levels. Glutathione S-transferase-binding assays revealed that AKAP13 bound to the VDR through its nuclear receptor interacting region. Cotransfection of AKAP13 and VDR significantly reduced vitamin D-dependent gene activation. RhoA pathway inhibition partially relieved repression of vitamin D-dependent gene activation by AKAP13. CONCLUSION(S) These data suggest that AKAP13 inhibited the vitamin D receptor activation by a mechanism that required, at least in part, RhoA activation.
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Affiliation(s)
- Chantel I Cross
- Department of Gynecology and Obstetrics, Division of Reproductive Endocrinology and Infertility, Johns Hopkins University School of Medicine, Baltimore, Maryland.
| | - Paul H Driggers
- Department of Gynecology and Obstetrics, Division of Reproductive Sciences and Women's Health Research, Johns Hopkins Medicine, Baltimore, Maryland
| | - Breanne E McCarthy
- Department of Gynecology and Obstetrics, Division of Reproductive Endocrinology and Infertility, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Maya Diab
- BS, American University of Beirut Medical Center, Beirut, Lebanon
| | - Joshua Brennan
- Department of Gynecology and Obstetrics, Division of Reproductive Sciences and Women's Health Research, Johns Hopkins Medicine, Baltimore, Maryland
| | - James H Segars
- Department of Gynecology and Obstetrics, Division of Reproductive Sciences and Women's Health Research, Johns Hopkins Medicine, Baltimore, Maryland
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18
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Coutinho LM, Assis WA, Spagnuolo-Souza A, Reis FM. Uterine Fibroids and Pregnancy: How Do They Affect Each Other? Reprod Sci 2021; 29:2145-2151. [PMID: 34142343 DOI: 10.1007/s43032-021-00656-6] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Accepted: 06/09/2021] [Indexed: 01/20/2023]
Abstract
The present narrative review is aimed to rekindle discussion regarding whether and how uterine leiomyoma and pregnancy may impact each other. Although fibroids are hormone-dependent lesions, their growth during pregnancy seems to have a nonlinear trend. Besides placental estrogens and progesterone, an array of endocrine and paracrine factors affect fibroid blood supply, growth rate, and risk of degeneration along the gestational and puerperal periods. According to current evidence, the presence of leiomyomas might increase the risk of some adverse pregnancy outcomes. Although a causative relation between fibroids and spontaneous abortion is questionable, the presence of multiple submucosal lesions in certain populations, such as infertile women, may increase the risk of pregnancy loss. Slightly increased risks of placenta previa, placental abruption and fetal malpresentation may occur, mainly due to the mechanical influence of multiple and large fibroids. Cesarean section and preterm birth rates are also probably increased in the presence of fibroids. The risk associations are based on meta-analyses of cohort studies (level of evidence 2a), retrospective cohort studies (2b), case-control (3a), and cross-sectional studies (3b), but with a predominantly low risk of bias. For evaluating the growth pattern of leiomyomas and their real influence on obstetric outcomes, future studies should enroll women with fibroids diagnosed prior to pregnancy and follow them prospectively throughout the gestation and puerperium.
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Affiliation(s)
- Larissa M Coutinho
- Department of Maternal and Child Health, Universidade Federal de Juiz de Fora, Juiz de Fora, Brazil.,Department of Obstetrics and Gynecology, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Wiviane A Assis
- Department of Obstetrics and Gynecology, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Ananda Spagnuolo-Souza
- Department of Obstetrics and Gynecology, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Fernando M Reis
- Department of Obstetrics and Gynecology, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil. .,Division of Human Reproduction, Department of Ob/Gyn, Hospital das Clínicas, UFMG, Av. Alfredo Balena, 110, 9° andar, Belo Horizonte, MG, 30130-100, Brazil.
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19
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Abdullah RK, Massey IY, Liu N, Zhao Y, Zeng H. The differences in characteristics of uterine leiomyomas and the diverse adverse pregnancy outcomes. J OBSTET GYNAECOL 2021; 41:841-847. [PMID: 33615961 DOI: 10.1080/01443615.2020.1846020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Although previous studies have shown a relationship between uterine leiomyoma and pregnancy outcomes, this relationship is not yet completely understood. Many review articles have addressed this effect, but to date, none has classified this relationship according to the characteristics of the leiomyoma (i.e., type, size, number, and location). This review was conducted to evaluate and classify the relationship between leiomyoma characteristics and the effects of a leiomyoma on pregnancy and prenatal outcomes to facilitate decision-making in preconception and prenatal counselling. We examined articles published in English regarding any leiomyoma characteristics with obstetric outcomes during pregnancy using a collection of subject headings and key terms: 'leiomyomata,' 'myoma,' 'leiomyoma,' 'fibroid,' and 'pregnancy.' Many studies regarding the influence of leiomyoma characteristics on outcomes of pregnancy were identified, and the common conclusion was that the outcomes were dependent on leiomyoma characteristics. Most studies focussed on leiomyoma size, followed by type, location, and number of lesions. Different leiomyoma characteristics are related to diverse pregnancy outcomes. Therefore, it may be possible to predict the extent of the effects of these tumours on pregnancy outcomes by identifying all leiomyoma characteristics.
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Affiliation(s)
- Raed K Abdullah
- Reproductive Medical Center, Xiangya Hospital, Central South University, Changsha City, People's Republic of China
| | - Isaac Y Massey
- Xiangya School of Public Health, Central South University, Changsha, People's Republic of China
| | - Nenghui Liu
- Reproductive Medical Center, Xiangya Hospital, Central South University, Changsha City, People's Republic of China
| | - Yuhao Zhao
- Reproductive Medical Center, Xiangya Hospital, Central South University, Changsha City, People's Republic of China
| | - Hong Zeng
- Reproductive Medical Center, Xiangya Hospital, Central South University, Changsha City, People's Republic of China
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20
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Rafiq S, Posh S, Nisa Quraishi A, Wani S. Obstetric Outcome in Pregnancies Complicated with Fibroids: A Prospective Observational Study. MATRIX SCIENCE MEDICA 2021. [DOI: 10.4103/mtsm.mtsm_39_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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21
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Rault E, Delorme P, Goffinet F, Girault A. Impact of history of myomectomy on preterm birth risk in women with a leiomyomatous uterus: a propensity score analysis. BMC Pregnancy Childbirth 2020; 20:720. [PMID: 33228570 PMCID: PMC7686718 DOI: 10.1186/s12884-020-03413-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Accepted: 11/12/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND To evaluate if women with a history of myomectomy have a modified preterm birth risk compared to women with myomas during pregnancy. METHODS Retrospective cohort study including all women with a history of myomectomy (operated group) or uterine myomas during pregnancy (unoperated group) who delivered in a tertiary center between January, 2011 and December, 2017. The operated group included women who had a myomectomy history with or without myomas during the ongoing pregnancy. The unoperated group included women with uterine myoma(s) seen on at least one ultrasound during pregnancy without history of myomectomy. The primary outcome was preterm birth < 37 weeks, and the secondary outcome spontaneous preterm birth < 37 weeks. To control for confounding factors, a propensity score approach was used. Two sensitivity analysis were performed, one repeating the analysis using the propensity score after excluding operated women with persistent myomas and one using a classical multivariable logistic regression model. RESULTS The cohort included 576 women: 283 operated women and 293 unoperated women. The rate of preterm birth was similar in the two groups: 12.6% in the unoperated group and 12.0% in the operated group (p = 0.82). No difference in preterm birth risk was shown between unoperated and operated women in the cohort matched on the propensity score: OR 0.86; 95%CI [0.47-1.59]. These results were consistent for spontaneous preterm birth (OR 1.61; 95%CI [0.61-4.23]) and for the sensitivity analyses. CONCLUSION In women with a leiomyomatous uterus, a history of myomectomy is not associated with a reduced preterm birth risk.
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Affiliation(s)
- Emmanuel Rault
- Maternité Port Royal, AP-HP, Hôpital Cochin, FHU PREMA, F-75014, Paris, France
| | - Pierre Delorme
- Maternité Port Royal, AP-HP, Hôpital Cochin, FHU PREMA, F-75014, Paris, France.,Université de Paris, INSERM UMR 1153, Obstetrical, Perinatal and Pediatric Epidemiology Research Team (Epopé), Center for Epidemiology and Statistics, FHU PREMA, Université de Paris, 123 boulevard Port Royal, 75014, Paris, France
| | - François Goffinet
- Maternité Port Royal, AP-HP, Hôpital Cochin, FHU PREMA, F-75014, Paris, France.,Université de Paris, INSERM UMR 1153, Obstetrical, Perinatal and Pediatric Epidemiology Research Team (Epopé), Center for Epidemiology and Statistics, FHU PREMA, Université de Paris, 123 boulevard Port Royal, 75014, Paris, France
| | - Aude Girault
- Maternité Port Royal, AP-HP, Hôpital Cochin, FHU PREMA, F-75014, Paris, France. .,Université de Paris, INSERM UMR 1153, Obstetrical, Perinatal and Pediatric Epidemiology Research Team (Epopé), Center for Epidemiology and Statistics, FHU PREMA, Université de Paris, 123 boulevard Port Royal, 75014, Paris, France.
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22
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Nirgianakis K, Kalaitzopoulos DR, Schwartz ASK, Spaanderman M, Kramer BW, Mueller MD, Mueller M. Fertility, pregnancy and neonatal outcomes of patients with adenomyosis: a systematic review and meta-analysis. Reprod Biomed Online 2020; 42:185-206. [PMID: 33191131 DOI: 10.1016/j.rbmo.2020.09.023] [Citation(s) in RCA: 51] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Revised: 09/23/2020] [Accepted: 09/24/2020] [Indexed: 02/08/2023]
Abstract
This study aimed to investigate the association of adenomyosis with fertility, pregnancy and neonatal outcomes. An electronic search was conducted using the MEDLINE, PubMed and Cochrane databases up to April 2020. Seventeen observational studies were included. Adenomyosis was significantly associated with a lower clinical pregnancy rate (odds ratio [OR] 0.69; 95% confidence interval [CI] 0.51-0.94) and higher miscarriage rate (OR 2.17; 95% CI 1.25-3.79) after treatment with assisted reproductive technology (ART). The lower clinical pregnancy rate was more significant in the subgroup of patients with short down-regulation protocols. Similar associations were recorded after age adjustment. Adenomyosis was also significantly associated with an increased risk of pre-eclampsia, preterm delivery, Caesarean section, fetal malpresentation, small for gestational age infancy and post-partum haemorrhage, which was confirmed after correction for age and mode of conception. In conclusion, adenomyosis is associated with negative effects on fertility after ART. The potentially protective role of the ultra-long down-regulation protocols needs further evaluation in randomized controlled studies. Adenomyosis is also associated (independently of the mode of conception) with adverse pregnancy and neonatal outcomes. Proper counselling prior to ART and close monitoring of pregnancy in patients with adenomyosis should be recommended.
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Affiliation(s)
- Konstantinos Nirgianakis
- Department of Obstetrics and Gynecology, University Hospital and University of Bern, Bern 3010, Switzerland.
| | | | - Alexandra S Kohl Schwartz
- Department of Obstetrics and Gynecology, University Hospital and University of Bern, Bern 3010, Switzerland
| | - Marc Spaanderman
- Department of Obstetrics and Gynecology, Department of Pediatrics, School for Oncology and Developmental Biology (GROW), Maastricht University Medical Center, Maastricht HX 6229, the Netherlands
| | - Boris W Kramer
- Department of Obstetrics and Gynecology, Department of Pediatrics, School for Oncology and Developmental Biology (GROW), Maastricht University Medical Center, Maastricht HX 6229, the Netherlands
| | - Michael D Mueller
- Department of Obstetrics and Gynecology, University Hospital and University of Bern, Bern 3010, Switzerland
| | - Martin Mueller
- Department of Obstetrics and Gynecology, University Hospital and University of Bern, Bern 3010, Switzerland; Department of Obstetrics and Gynecology, Department of Pediatrics, School for Oncology and Developmental Biology (GROW), Maastricht University Medical Center, Maastricht HX 6229, the Netherlands
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23
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Kim ML, Hong K, Kim S, Lee MJ, Shim SS, Hur YM, Shin JS. Twin pregnancies with uterine fibroids are not at increased risk for obstetric complications: single center cohort study. BMC Pregnancy Childbirth 2020; 20:222. [PMID: 32295544 PMCID: PMC7161148 DOI: 10.1186/s12884-020-02908-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2019] [Accepted: 03/27/2020] [Indexed: 11/10/2022] Open
Abstract
Background Twin pregnancies with uterine fibroid(s) (UFs) may not be at increased risk for obstetric complications compared to those without UFs. However, there was no reported comparison study with obstetric outcomes and complications of twin pregnancy after myomectomy. We aimed to compare the pregnancy outcomes in twin pregnancies with or without uterine fibroid(s), and also compared in patients with previous myomectomy history in Korean women. Methods A cohort of twin pregnancies delivered in a single institution between January 2011 and March 2019 were retrospectively analyzed. UFs group was defined by the presence of UFs during pregnancy (≥1 fibroid, measuring ≥2 cm or multiple fibroids regardless of the size). Previous myomectomy group included patients with history of abdominal or laparoscopic or hysteroscopic myomectomy of ≥1 fibroid, measuring ≥2 cm or multiple fibroids whatever the size. Patients with monochorionic monoamniotic twins, myoma less than 2 cm in size, missed abortion or intrauterine fetal death (IUFD) of one fetus before 14 weeks, history of previous conization, and uterine anomalies were excluded. Pregnancy outcomes and obstetric complications were compared. Result A total 1388 patients were included in this study, 191 (13.8%) had UFs and 89 (6.4%) had a history of myomectomy. Maternal age was younger in non-UFs group and primiparity was more common in UFs group (p < 0.001, and p = 0.019). No significant differences were found in the gestational age at delivery (p = 0.657), delivery before 37 weeks (p = 0.662), delivery before 34 weeks (p = 0.340), and sum of birth weight of twin (p = 0.307). There were also no statistical differences in rates of obstetrical complications, such as preeclampsia, gestational diabetes mellitus, placenta previa, placenta abruption, cerclage, small for gestational age, IUFD, postpartum hemorrhage and peripartum transfusion or ICU care. These obstetrical outcomes and complications showed no statistical differences between UFs group and previous myomectomy group. Conclusion In patients with twin pregnancies, the presence of UFs or history of previous myomectomy did not relate to negative effects on pregnancy outcomes and obstetrical complications.
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Affiliation(s)
- Mi-La Kim
- Department of Obstetrics and Gynecology, CHA Gangnam Medical Center, CHA University, 566, Nonhyeon-ro, Gangnam-gu, Seoul, 135-081, Republic of Korea
| | - Kirim Hong
- Department of Obstetrics and Gynecology, CHA Gangnam Medical Center, CHA University, 566, Nonhyeon-ro, Gangnam-gu, Seoul, 135-081, Republic of Korea
| | - Sohyun Kim
- Department of Obstetrics and Gynecology, CHA Gangnam Medical Center, CHA University, 566, Nonhyeon-ro, Gangnam-gu, Seoul, 135-081, Republic of Korea
| | - Min Jin Lee
- Department of Obstetrics and Gynecology, CHA Gangnam Medical Center, CHA University, 566, Nonhyeon-ro, Gangnam-gu, Seoul, 135-081, Republic of Korea
| | - Sung Shin Shim
- Department of Obstetrics and Gynecology, CHA Gangnam Medical Center, CHA University, 566, Nonhyeon-ro, Gangnam-gu, Seoul, 135-081, Republic of Korea
| | - Yoon-Mi Hur
- College of General Education, Kookmin University, Seoul, Republic of Korea
| | - Joong Sik Shin
- Department of Obstetrics and Gynecology, CHA Gangnam Medical Center, CHA University, 566, Nonhyeon-ro, Gangnam-gu, Seoul, 135-081, Republic of Korea.
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24
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Hatırnaz Ş, Güler O, Başbuğ A, Çetinkaya MB, Kanat-Pektaş M, Bakay K, Çelik S, Şentürk Ş, Soyer-Çalışkan C, Gürçağlar A, Şahin B, Kalkan Ü, Çelik H, Kalyoncu Ş, Bıyık İ, Yassa M, Erol O, Akarsu S, Turhan U, Ulubaşoğlu H, Sparic R, Tinelli A. A Comparative Multicentric Study on Serosal and Endometrial Myomectomy During Cesarean Section: Surgical Outcomes. J INVEST SURG 2020; 34:687-694. [DOI: 10.1080/08941939.2020.1725188] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- Şafak Hatırnaz
- Medicana Samsun International Hospital, IVF Center, Sansun, Turkey
| | - Oğuz Güler
- Department of Obstetrics and Gynecology, Bilge Hastanesi, Istanbul, Turkey
| | - Alper Başbuğ
- Department of Obstetrics and Gynecology, School of Medicine, Duzce University, Duzce, Turkey
| | - Mehmet Bilge Çetinkaya
- Department of Obstetrics and Gynecology, School of Medicine, Ondokuzmayis University, Samsun, Turkey
| | - Mine Kanat-Pektaş
- Department of Obstetrics and Gynecology, School of Medicine, Kocatepe University, Afyon, Turkey
| | - Kadir Bakay
- Department of Obstetrics and Gynecology, School of Medicine, Ondokuzmayis University, Samsun, Turkey
| | - Samettin Çelik
- Maternity Hospital, Samsun Training and Research Hospital, Samsun, Turkey
| | - Şenol Şentürk
- Department of Obstetrics and Gynecology, School of Medicine, Recep Tayyip Erdoğan University, Rize, Turkey
| | | | - Aysemin Gürçağlar
- Department of Obstetrics and Gynecology, School of Medicine, Amasya University, Amasya, Turkey
| | - Banuhan Şahin
- Department of Obstetrics and Gynecology, School of Medicine, Amasya University, Amasya, Turkey
| | - Üzeyir Kalkan
- Department of Obstetrics and Gynecology, Özel Egemed Hospital Söke, Aydın, Turkey
| | - Handan Çelik
- Department of Obstetrics and Gynecology, School of Medicine, Ondokuzmayis University, Samsun, Turkey
| | - Şenol Kalyoncu
- Department of Obstetrics and Gynecology, Private Office, Ankara, Turkey
| | - İsmail Bıyık
- Department of Obstetrics and Gynecology, Kütahya Sağlık Bilimleri Üniversitesi, Kütahya, Turkey
| | - Murat Yassa
- Department of Obstetrics and Gynecology, Sağlık Bilimleri Üniversitesi, Şişli Etfal Hastanesi, İstanbul, Turkey
| | - Onur Erol
- Department of Obstetrics and Gynecology, Sağlık Bilimleri Üniversitesi, Antalya Eğitimve Araştırma Hastanesi, Antalya, Turkey
| | | | - Uğur Turhan
- Maternity Hospital, Samsun Training and Research Hospital, Samsun, Turkey
| | - Hasan Ulubaşoğlu
- Maternity Hospital, Samsun Training and Research Hospital, Samsun, Turkey
| | - Radmila Sparic
- Clinic of Gynecology and Obstetrics, Clinical Center of Serbia, Višegradska, Serbia
- School of Medicine, University of Belgrade, Serbia
| | - Andrea Tinelli
- Department of Obstetrics and Gynecology, Division of Experimental Endoscopic Surgery, Imaging, Technology and Minimally Invasive Therapy, Lecce, Italy
- Laboratory of Human Physiology, PhystechBioMed School, Faculty of Biological & Medical Physics, Moscow Institute of Physics and Technology (State University), Dolgoprudny, Moscow Region, Russia
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Karlsen K, Schiøler Kesmodel U, 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:e032104. [PMID: 32071172 PMCID: PMC7044982 DOI: 10.1136/bmjopen-2019-032104] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
OBJECTIVE The aim was to investigate the association between clinically significant uterine fibroids and preterm birth, caesarean section (CS), postpartum haemorrhage (PPH), placental abruption, intrauterine growth restriction (IUGR) and uterine rupture. METHODS, PARTICIPANTS AND SETTING A historical cohort study based on data from the Danish National Birth Cohort, the Danish National Patient Registry and the Danish National Birth Registry (DNBR). The final study population consisted of 92 696 pregnancies and was divided into four groups for comparison. Group 1: pregnancies of women without a fibroid diagnosis code or fibroid operation code; group 2: pregnancies of women with a fibroid diagnosis code before pregnancy, during pregnancy or up to 1 year after delivery, and no fibroid operation code before pregnancy; group 3: pregnancies of women with a fibroid diagnosis code given more than 1 year after delivery; and group 4: pregnancies of women with a fibroid operation code given before pregnancy. RESULTS A diagnosis of fibroids before pregnancy yielded an increased risk of preterm birth (gestational age (GA) ≤37 weeks) (OR 2.27 (1.30─3.96)) and extreme preterm birth (GA 22+0─27+6 weeks, OR 20.09 (8.04─50.22)). The risk of CS was increased (OR 1.83 (1.23─2.72)) for women with a fibroid diagnosis code given before pregnancy; significantly increased risk of elective CS (OR 1.92 (1.11─3.32)), but not acute CS (OR 1.54 (0.94─2.52)). The risks of PPH, placental abruption or IUGR were not increased in any of the groups. CONCLUSION We found a strong association between clinically significant uterine fibroids and preterm birth, and an association between clinically significant uterine fibroids and CS. In contrast, no association between clinically significant uterine fibroids and PPH, placental abruption or IUGR was seen.
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Affiliation(s)
- Kamilla Karlsen
- Gynecology and Obstetrics, Clinical Institute University of Southern Denmark, Odense, Denmark
| | - Ulrik Schiøler Kesmodel
- Research Unit of Gynecology, Institute of Clinical Research, University of Southern Denmark, Odense, Denmark
- Department of Clinical Medicine, Aalborg Universitet, Aalborg, Denmark
| | - Ole Mogensen
- Department of Gynecology, Aarhus University Hospital and Faculty of Health, Aarhus University, Aarhus, Denmark
| | - Peter Humaidan
- Skive Regional Hospital, The Fertility Clinic, Skive, Denmark
- Faculty of Health, Aarhus Universitet, Aarhus, Denmark
| | - Pernille Ravn
- Clinical Institute, Syddansk Universitet, Odense, Denmark
- Department of Gynecology and Obstetrics, Odense University Hospital, Odense, Denmark
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Niu X, Li CI, Mueller BA. Obstetrical and infant outcomes among women with neoplasms during pregnancy. Cancer Causes Control 2019; 30:651-661. [PMID: 30976958 DOI: 10.1007/s10552-019-01167-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2018] [Accepted: 04/05/2019] [Indexed: 02/03/2023]
Abstract
PURPOSE One in 1,000 pregnancies is complicated by malignancies. Prevalence is greater for benign neoplasms. Adverse outcomes among women with malignancies have been reported. Less is known of postpartum outcomes for infants, or outcomes among women with benign neoplasms. METHODS We conducted a population-based cohort study using Washington State-linked vital-hospital discharge records. Women with neoplasms (707 malignant; 13,156 benign) with deliveries in 1987-2012 were identified, and a randomly selected comparison cohort. Obstetrical/infant outcomes and rehospitalization < 2 years post-delivery were compared separately for each group by multivariable regressions to estimate risk ratios (RR) and 95% confidence intervals (CI). RESULTS Women with either condition had increased anemia, cesarean, and preterm delivery; their infants were more often < 2,500 g or jaundiced. Women with benign conditions had increased gestational diabetes (RR = 1.20; 95% CI 1.12-1.28) and preeclampsia (RR = 1.27; 95% CI 1.18-1.36); their infants had increased malformations (RR = 1.29; 95% CI 1.19-1.38). Women with neoplasms more often were hospitalized seven or more days or rehospitalized; their infants' hospitalizations were also longer. CONCLUSION Malignant and benign neoplasms were associated with several adverse outcomes. Reasons for relationships of benign neoplasms with gestational diabetes, preeclampsia, and congenital malformations merit further study.
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Affiliation(s)
- Xin Niu
- Department of Epidemiology, University of Washington (UW), Seattle, WA, USA
| | - Christopher I Li
- Department of Epidemiology, University of Washington (UW), Seattle, WA, USA
- Public Health Sciences Division, Fred Hutchinson Cancer Research Center (FHCRC), PO 19024, Mailstop M4-C308, Seattle, WA, 98109-1024, USA
| | - Beth A Mueller
- Department of Epidemiology, University of Washington (UW), Seattle, WA, USA.
- Public Health Sciences Division, Fred Hutchinson Cancer Research Center (FHCRC), PO 19024, Mailstop M4-C308, Seattle, WA, 98109-1024, USA.
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Outcomes of Myomectomy at the Time of Cesarean Section among Pregnant Women with Uterine Fibroids: A Retrospective Cohort Study. BIOMED RESEARCH INTERNATIONAL 2019; 2019:7576934. [PMID: 30956984 PMCID: PMC6431434 DOI: 10.1155/2019/7576934] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/03/2019] [Accepted: 02/21/2019] [Indexed: 11/18/2022]
Abstract
Objective A retrospective study was performed to evaluate the safety and feasibility of cesarean myomectomy among pregnant women with uterine fibroids (UFs). Methods Upon data collection, the pregnant women with UF underwent cesarean section in the 39 hospital divided into two groups: cesarean myomectomy group, receiving cesarean section and myomectomy; cesarean group, receiving cesarean section only. Information about the type, location, and number of UFs was collected from the medical records or the prenatal ultrasound examinations. Results In the cesarean myomectomy group, the proportion of subserous UFs was significantly higher than the cesarean group (65.6% versus 49.3%, P < 0.0001). The comparison of postpartum hemorrhage, neonatal weight, fetal distress, and neonatal asphyxia showed no statistical significance. Multivariate logistic regression analysis demonstrated that birth weight ≥4000 g (OR 3.1, 95% CI:1.6–6.0) and presence of diameter > 5 cm fibroids (OR 2.2, 95%CI:1.3–4.0) were high risk factors for PPH ≥1,000 ml. Conclusions Myomectomy during cesarean section was a common procedure in mainland China. Myomectomy cesarean could be safe and feasible based on the estimation by experienced obstetricians. During the procedure, special attention should be paid to a large-sized leiomyoma ≥5cm and birth weight ≥4,000 g.
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Kriplani A, Mahey R, Kachhawa G, Kriplani I, Goel T, Kalaivani M. Cesarean Myomectomy: Experience at a Tertiary-Care Center. J Gynecol Surg 2018. [DOI: 10.1089/gyn.2017.0135] [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)
- Alka Kriplani
- Department of Obstetrics and Gynaecology, All India Institute of Medical Sciences, New Delhi, India
| | - Reeta Mahey
- Department of Obstetrics and Gynaecology, All India Institute of Medical Sciences, New Delhi, India
| | - Garima Kachhawa
- Department of Obstetrics and Gynaecology, All India Institute of Medical Sciences, New Delhi, India
| | - Isha Kriplani
- Department of Obstetrics and Gynaecology, All India Institute of Medical Sciences, New Delhi, India
| | - Tuhina Goel
- Department of Obstetrics and Gynaecology, All India Institute of Medical Sciences, New Delhi, India
| | - Mani Kalaivani
- Department of Statistics, All India Institute of Medical Sciences, New Delhi, India
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Does Uterine Fibroid Adversely Affect Obstetric Outcome of Pregnancy? BIOMED RESEARCH INTERNATIONAL 2018; 2018:8367068. [PMID: 30151390 PMCID: PMC6087613 DOI: 10.1155/2018/8367068] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/28/2017] [Revised: 01/12/2018] [Accepted: 01/22/2018] [Indexed: 11/17/2022]
Abstract
Background Fibroid is the most common benign tumor of the uterus and if associated with pregnancy may adversely affect the outcome of pregnancy. Objective of the present study was to assess the obstetric outcome (maternal and fetal) in pregnancy with fibroid. Methods A prospective observational study was performed over a period from May 2015 to August 2017 at Obstetrics and Gynecology Department in Zagazig University Hospitals, Egypt. 64 pregnant patients with >2 cm fibroid were taken in the study. Routine fundamental investigations were done for all. They were followed during antenatal period clinically and scanned by ultrasonogram which was done at booking visit and during subsequent visits to assess the change in the size of the fibroid and other obstetric complications. Maternal age, parity, size of fibroid, complications during pregnancy, and mode of delivery were noted. Results 64 pregnant patients with uterine fibroids were recruited; 47 of them completed the study to the end. The average age was 31.80 ± 3.27 years, body mass index (BMI) [calculated as weight in kilograms divided by the square of height in meters] was 24.67 ± 2.46, primigravida was 23.4%, multigravida was 76.6%, duration of menstrual cycle/day was 29.68 ± 3.10, and duration of menstrual period/day was 6.46 ± 1.12. The percentage of spontaneous conception was 59.57% and 40.43% for using assisted reproductive technology. The results of obstetric outcome were spontaneous abortion in 2%, premature delivery in 27.7%, and delivery at 37–41 weeks of pregnancy in 70.2%. The mode of delivery was vaginal delivery in 15% and cesarean sections in 85%. Also, 34% had threatened miscarriage, 21% had preterm labor, 2% had antepartum bleeding in the form of placenta previa, 4% had abdominal pain needing admission, one of them underwent laparotomy and was diagnosed as red degeneration, 2 (4%) had postpartum hemorrhage, and only one needed blood transfusion. Cesarean sections were done in 85%. Neonatal outcome was acceptable with no perinatal mortality. There were no significant differences between patients with single or multiple fibroids as regards the obstetric outcome or type of fibroid either intramural or subserosal. The obstetric outcomes were not significantly affected by the number, size, or type of fibroids. Conclusions Even most of fibroids in pregnancy are asymptomatic but may be associated with some complications affecting the course of pregnancy and labor. So, pregnancy has to be cautiously screened in the antenatal period, through regular follow-up, to detect any adverse obstetric complications and so improve the outcome.
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Zhao R, Wang X, Zou L, Li G, Chen Y, Li C, Zhang W. Adverse obstetric outcomes in pregnant women with uterine fibroids in China: A multicenter survey involving 112,403 deliveries. PLoS One 2017; 12:e0187821. [PMID: 29136018 PMCID: PMC5685483 DOI: 10.1371/journal.pone.0187821] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2016] [Accepted: 09/29/2017] [Indexed: 11/23/2022] Open
Abstract
Objective To estimate the association between uterine fibroids and adverse obstetric outcomes. Methods This was a retrospective cross-sectional study of 112,403 deliveries from 14 provinces and 39 different hospitals in 2011 in mainland China. We compared pregnancy outcomes in women with and without uterine fibroids who underwent detailed second trimester obstetric ultrasonography during 18 to 22 weeks. Obstetric outcomes include cesarean delivery, breech presentation, preterm delivery, placenta previa, placental abruption, premature rupture of membranes and neonatal birthweight. Univariate analyses and multivariate logistic regression analyses were performed. Results Of 112,403 women who underwent routine obstetric survey, 3,012 (2.68%) women were identified with at least 1 fibroid. By univariate and multivariate analyses, the presence of uterine fibroids was significantly associated with cesarean delivery (Adjusted odds radio [AOR] 1.8, 95% confidence interval [CI] 1.7–2.0), breech presentation (AOR 1.3, 95% CI 1.2–1.5) and postpartum hemorrhage (AOR 1.2, 95% CI 1.1–1.4). The size of uterine fibroids and location in uterus had important effect on the mode of delivery. The rates of PPH were significantly higher with increasing size of the uterine fibroid (P<0.001). And the location of fibroid (intramural, submucosal or subserosal) also have a statistically significant impact on the risk of PPH (5.6% [subserosal] vs 4.7% [submucosal] vs 8.6% [intramural]). Conclusion Pregnant women with uterine fibroids are at increased risk for cesarean delivery, breech presentation and postpartum hemorrhage. And different characteristics of uterine fibroids affect obstetric outcomes through different ways. Such detailed information may be useful in risk-stratifying pregnant women with fibroids.
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Affiliation(s)
- Rong Zhao
- Department of Obstetric medicine, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing, People’s Republic of China
| | - Xin Wang
- Department of Obstetric medicine, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing, People’s Republic of China
| | - Liying Zou
- Department of Obstetric medicine, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing, People’s Republic of China
| | - Guanghui Li
- Department of Obstetric medicine, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing, People’s Republic of China
| | - Yi Chen
- Department of Obstetric medicine, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing, People’s Republic of China
| | - Changdong Li
- Department of Obstetric medicine, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing, People’s Republic of China
| | - Weiyuan Zhang
- Department of Obstetric medicine, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing, People’s Republic of China
- * E-mail:
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Milazzo GN, Catalano A, Badia V, Mallozzi M, Caserta D. Myoma and myomectomy: Poor evidence concern in pregnancy. J Obstet Gynaecol Res 2017; 43:1789-1804. [PMID: 28892210 DOI: 10.1111/jog.13437] [Citation(s) in RCA: 50] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2017] [Revised: 05/21/2017] [Accepted: 05/28/2017] [Indexed: 02/02/2023]
Abstract
AIM Summarize the results of the many, but often underpowered, studies on pregnancy complicated by myoma or myomectomy. METHODS Survey of the electronic PubMed database for the last two decades was conducted. We selected reviews, meta-analyses, case series, case reports, clinical studies only with statistical analysis, and guidelines from scientific societies. RESULTS Delaying childbearing leads to an increased incidence of pregnancy complicated by fibroids or previous myomectomy. Approximately 10-30% of pregnant women with myomas develop complications during gestation, at delivery and in puerperium. Submucosal, retroplacental, large and multiple myomas have a greater risk of complications. Cervical myomas, although rare, need careful management. The location and size of the fibroids should be assessed from the first trimester. Despite the increased risk of cesarean section, fibroids are not a contraindication to labor, unless they obstruct the birth canal or other obstetric conditions coexist. Myomectomy during pregnancy, in selected cases, is feasible and safe. Myomectomy cannot be considered a prophylactic measure prior to conception, but has to be individualized. Uterine rupture after myomectomy generally occurs in the third trimester or during labor and some associated risk factors have been identified. There is no consensus on the optimal interval between myomectomy and conception. CONCLUSIONS Pregnancy in patients with fibroids or previous myomectomy should be considered as high risk, requiring a maternal-fetal medicine specialist. To date available literature is inconsistent on evidence-based management. Further research is needed for definitive recommendations.
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Affiliation(s)
- Giusi Natalia Milazzo
- Department of Medical and Surgical Sciences and Translational Medicine, Sant'Andrea Hospital, University of Rome "Sapienza", Rome, Italy
| | - Angelica Catalano
- Department of Medical and Surgical Sciences and Translational Medicine, Sant'Andrea Hospital, University of Rome "Sapienza", Rome, Italy
| | - Valentina Badia
- Department of Medical and Surgical Sciences and Translational Medicine, Sant'Andrea Hospital, University of Rome "Sapienza", Rome, Italy
| | - Maddalena Mallozzi
- Department of Medical and Surgical Sciences and Translational Medicine, Sant'Andrea Hospital, University of Rome "Sapienza", Rome, Italy
| | - Donatella Caserta
- Department of Medical and Surgical Sciences and Translational Medicine, Sant'Andrea Hospital, University of Rome "Sapienza", Rome, Italy
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An unusual case of right upper quadrant pain in a pregnant woman. JAAPA 2017; 30:29-30. [PMID: 28350728 DOI: 10.1097/01.jaa.0000511032.57069.85] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Uterine fibroids occur in up to 30% of women of reproductive age and can cause complications during pregnancy that can harm mother and fetus, such as prematurity and increased risk of miscarriage. This article describes a pregnant woman whose abdominal pain was diagnosed as degenerating uterine fibroids.
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Donnez J, Dolmans MM. Uterine fibroid management: from the present to the future. Hum Reprod Update 2016; 22:665-686. [PMID: 27466209 PMCID: PMC5853598 DOI: 10.1093/humupd/dmw023] [Citation(s) in RCA: 351] [Impact Index Per Article: 43.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2016] [Revised: 05/12/2016] [Accepted: 05/27/2016] [Indexed: 12/24/2022] Open
Abstract
Uterine fibroids (also known as leiomyomas or myomas) are the most common form of benign uterine tumors. Clinical presentations include abnormal bleeding, pelvic masses, pelvic pain, infertility, bulk symptoms and obstetric complications.Almost a third of women with leiomyomas will request treatment due to symptoms. Current management strategies mainly involve surgical interventions, but the choice of treatment is guided by patient's age and desire to preserve fertility or avoid 'radical' surgery such as hysterectomy. The management of uterine fibroids also depends on the number, size and location of the fibroids. Other surgical and non-surgical approaches include myomectomy by hysteroscopy, myomectomy by laparotomy or laparoscopy, uterine artery embolization and interventions performed under radiologic or ultrasound guidance to induce thermal ablation of the uterine fibroids.There are only a few randomized trials comparing various therapies for fibroids. Further investigations are required as there is a lack of concrete evidence of effectiveness and areas of uncertainty surrounding correct management according to symptoms. The economic impact of uterine fibroid management is significant and it is imperative that new treatments be developed to provide alternatives to surgical intervention.There is growing evidence of the crucial role of progesterone pathways in the pathophysiology of uterine fibroids due to the use of selective progesterone receptor modulators (SPRMs) such as ulipristal acetate (UPA). The efficacy of long-term intermittent use of UPA was recently demonstrated by randomized controlled studies.The need for alternatives to surgical intervention is very real, especially for women seeking to preserve their fertility. These options now exist, with SPRMs which are proven to treat fibroid symptoms effectively. Gynecologists now have new tools in their armamentarium, opening up novel strategies for the management of uterine fibroids.
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Affiliation(s)
- Jacques Donnez
- Professor EM, Catholic University of Louvain, Director, Société de Recherche pour l'Infertilité (SRI), 143 Avenue Grandchamp, B-1150 Brussels, Belgium
| | - Marie-Madeleine Dolmans
- Gynecology Department, Cliniques Universitaires St-Luc, Avenue Hippocrate 10, 1200 Brussels, Belgium; Pôle de Gynécologie, Institut de Recherche Expérimentale et Clinique, Université Catholique de Louvain, Avenue Mounier 52, bte B1.52.02, 1200 Brussels, Belgium
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Palomba S, Santagni S, Gibbins K, La Sala GB, Silver RM. Pregnancy complications in spontaneous and assisted conceptions of women with infertility and subfertility factors. A comprehensive review. Reprod Biomed Online 2016; 33:612-628. [PMID: 27591135 DOI: 10.1016/j.rbmo.2016.08.007] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2015] [Revised: 08/10/2016] [Accepted: 08/11/2016] [Indexed: 12/20/2022]
Abstract
In the literature, there is growing evidence that assisted reproductive techniques increase the risk of pregnancy complications in subfertile couples. Moreover, many concomitant preconception risk factors for subfertility are frequently present in the same subject and increase the risk of pregnancy complications. This review aimed to summarize in a systematic fashion the best current evidence regarding the effects of preconception maternal factors on maternal and neonatal outcomes. A literature search up to March 2016 was performed in IBSS, SocINDEX, Institute for Scientific Information, PubMed, Web of Science and Google Scholar. An evidence-based hierarchy was used to determine which articles to include and analyse. Available data show that the risk of pregnancy complications in spontaneous and assisted conceptions is likely multifactorial, and the magnitude of this risk is probably very different according specific subgroups of patients. Notwithstanding the only moderate level and quality of the available evidence, available data suggest that the presence and the treatment of specific preconception cofactors of subfertility should be always taken into account both in clinical practice and for scientific purposes.
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Affiliation(s)
- Stefano Palomba
- Center of Reproductive Medicine and Surgery, Arcispedale Santa Maria Nuova (ASMN), Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Reggio Emilia, Italy.
| | - Susanna Santagni
- Center of Reproductive Medicine and Surgery, Arcispedale Santa Maria Nuova (ASMN), Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Reggio Emilia, Italy
| | - Karen Gibbins
- Division of Matenal-Fetal Medicine, Utah University, Salt Lake City, UT, USA
| | - Giovanni Battista La Sala
- Center of Reproductive Medicine and Surgery, Arcispedale Santa Maria Nuova (ASMN), Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Reggio Emilia, Italy; University of Modena and Reggio Emilia, Reggio Emilia, Italy
| | - Robert M Silver
- Division of Matenal-Fetal Medicine, Utah University, Salt Lake City, UT, USA
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Sparić R, Malvasi A, Kadija S, Babović I, Nejković L, Tinelli A. Cesarean myomectomy trends and controversies: an appraisal. J Matern Fetal Neonatal Med 2016; 30:1114-1123. [PMID: 27328626 DOI: 10.1080/14767058.2016.1205024] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
OBJECTIVE Although the first report on cesarean myomectomy (CM) was a century ago, the management of a myomectomy during a cesarean section (CS) remains controversial. The objective of this study is to provide the latest data on this topic regarding the techniques and complications of CM. METHODS The authors consulted the most important scientific databases investigating the indications and contraindications for CM, the operational techniques, benefits and complications. RESULTS CM provides the benefits of two surgeries in one laparotomy, avoiding the risks of repeated anesthesia and relaparotomy. Nevertheless, in some patients, CM may be associated with increased morbidity and, in such cases, an interval myomectomy might be a safer option. Myomas compromising fetal extraction and uterine incision and/or suturing should be preferably enucleated during CS. CM is generally considered relatively safe in cases of anterior wall myomas, subserous and pedunculated myomas, particularly if a myomectomy is feasible without additional hysterotomy. Multiple myomas, deep intramural, fundal and cornual myomas and posterior uterine wall myomas are associated with more surgical complications during CM. CONCLUSIONS With increasing reports in favor of CM, the risk-benefit ratio should be still evaluated with randomized controlled trials, in order to achieve more data on CM.
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Affiliation(s)
- Radmila Sparić
- a Clinic of Gynecology and Obstetrics, Clinical Center of Serbia , Belgrade , Serbia.,b School of Medicine, University of Belgrade , Belgrade , Serbia
| | - Antonio Malvasi
- c International Translational Medicine and Biomodeling Research Group, Department of Applied Mathematics Moscow Institute of Physics and Technology, Moscow State University, Russia.,d Department of Obstetrics & Gynecology , Santa Maria Hospital, GVM Care & Research , Bari , Italy
| | - Saša Kadija
- a Clinic of Gynecology and Obstetrics, Clinical Center of Serbia , Belgrade , Serbia.,b School of Medicine, University of Belgrade , Belgrade , Serbia
| | - Ivana Babović
- a Clinic of Gynecology and Obstetrics, Clinical Center of Serbia , Belgrade , Serbia.,b School of Medicine, University of Belgrade , Belgrade , Serbia
| | - Lazar Nejković
- e Clinic of Gynecology and Obstetrics "Narodni Front" , Belgrade , Serbia , and
| | - Andrea Tinelli
- c International Translational Medicine and Biomodeling Research Group, Department of Applied Mathematics Moscow Institute of Physics and Technology, Moscow State University, Russia.,f Division of Experimental Endoscopic Surgery , Imaging, Technology and Minimally Invasive Therapy, Department of Obstetrics and Gynecology Vito Fazzi Hospital , Lecce , Italy
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Wang HM, Tian YC, Xue ZF, Zhang Y, Dai YM. Associations between uterine fibroids and obstetric outcomes in twin pregnancies. Int J Gynaecol Obstet 2016; 135:22-7. [PMID: 27522320 DOI: 10.1016/j.ijgo.2016.04.013] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2015] [Revised: 04/26/2016] [Accepted: 07/01/2016] [Indexed: 10/21/2022]
Abstract
OBJECTIVE To examine potential associations between the presence of fibroids and obstetric outcomes in twin pregnancies. METHODS A prospective cohort study compared obstetric outcomes between individuals with twin pregnancies who did and did not have fibroids. Patients were considered for inclusion if they underwent first-trimester ultrasonography examination, and went on to deliver at the Beijing Obstetrics and Gynecology Hospital between September 1, 2012 and December 31, 2014. Participants were grouped based on the presence or absence of fibroids and baseline demographics, fibroid characteristics, and obstetric outcomes were recorded and compared between the two groups. RESULTS In total, 153 patients with twin pregnancies were recruited; 51 had fibroids and 102 did not. Patients in the fibroid group demonstrated a higher maternal age (P<0.001), higher pre-pregnancy body mass index (P=0.01), and higher rate of assisted reproductive technology use (P=0.04). The presence of fibroids was not associated with any change in obstetric outcomes, and obstetric outcomes were unaffected by the number, size, location, and type of fibroids (all P>0.05). CONCLUSION Fibroids were not a risk factor for any adverse obstetric outcomes among patients with twin pregnancies.
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Affiliation(s)
- Hong-Mei Wang
- Department of Gynecology, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing, China
| | - Yu-Cui Tian
- Department of Gynecology, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing, China
| | - Zhi-Fang Xue
- Department of Gynecology, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing, China
| | - Yue Zhang
- Department of Gynecology, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing, China
| | - Yin-Mei Dai
- Department of Gynecology, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing, China.
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Dinglas C, Kunzier N, Sanchi J, Chavez M, Vintzileos A. Ultrasound-guided manipulation of fetal entrapment by a large uterine fibroid. Am J Obstet Gynecol 2015; 213:870.e1-2. [PMID: 26226553 DOI: 10.1016/j.ajog.2015.07.041] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2015] [Accepted: 07/21/2015] [Indexed: 11/25/2022]
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Radhika BH, Naik K, Shreelatha S, Vana H. Case series: Pregnancy Outcome in Patients with Uterine Fibroids. J Clin Diagn Res 2015; 9:QR01-4. [PMID: 26557577 DOI: 10.7860/jcdr/2015/14375.6621] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2015] [Accepted: 08/19/2015] [Indexed: 11/24/2022]
Abstract
Fibroids in pregnancy is a commonly encountered clinical entity. Objective of this study was to evaluate the maternal and fetal outcome in women having pregnancy with uterine fibroids. We present the clinical, obstetric data, perinatal outcomes of 15 patients from a prospective study. Fifteen pregnant women with fibroid >3cm were prospectively included in study. Major proportion of patient with fibroids were in younger age group of 25-30 years when compared to older age group of 31-35 years (66% vs 33%). Fibroids were more frequent in multi-gravidae, compared to primigravidae. In almost half of patients, (53.3%) fibroids were diagnosed before pregnancy. Common complications encountered during pregnancy in decreasing order of frequency were pain abdomen (46.6%), followed by threatened preterm labour (26.6%) and anaemia (26.6%). Out of 15, three (20%) women had abortion. In remaining, 11/12 patients attained term pregnancy between 37 to 40 weeks. Two patients required antenatal myomectomy. Caesarean section was done in 75% of women who attained term pregnancy and one patient had technical difficulty during caesarean section. Post partum heamorrhage was seen in 5/15 (33.3%) of patients. Out of 12, five babies were low birth weight. Four babies required NICU admission. There was no perinatal mortality. In our small patient series high incidence of caesarean section rates and increased incidence of threatened preterm labour, anaemia, and postpartum haemorrhage, was observed in pregnant patients with fibroids and hence, the pregnancy with fibroids should be considered as high risk pregnancy.
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Affiliation(s)
- B H Radhika
- Senior Resident, Department of Obstetrics and Gynecology, ESI Post Graduate Institute of Medical Science and Research , Bangalore, India
| | - Kusuma Naik
- Assistant Professor, Department of Obstetrics and Gynecology, ESI Post Graduate Institute of Medical Science and Research , Bangalore, India
| | - S Shreelatha
- Associate Professor, Department of Obstetrics and Gynecology, ESI Post Graduate Institute of Medical Science and Research , Bangalore, India
| | - Harshini Vana
- Senior Resident, Department of Obstetrics and Gynecology, ESI Post Graduate Institute of Medical Science and Research , Bangalore, India
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Vannuccini S, Clifton VL, Fraser IS, Taylor HS, Critchley H, Giudice LC, Petraglia F. Infertility and reproductive disorders: impact of hormonal and inflammatory mechanisms on pregnancy outcome. Hum Reprod Update 2015; 22:104-15. [PMID: 26395640 PMCID: PMC7289323 DOI: 10.1093/humupd/dmv044] [Citation(s) in RCA: 208] [Impact Index Per Article: 23.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2015] [Accepted: 09/03/2015] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Reproductive disorders and infertility are associated with the risk of obstetric complications and have a negative impact on pregnancy outcome. Affected patients often require assisted reproductive technologies (ART) to conceive, and advanced maternal age is a further confounding factor. The challenge is to dissect causation, correlation and confounders in determining how infertility and reproductive disorders individually or together predispose women to poor pregnancy outcomes. METHODS The published literature, to June 2015, was searched using PubMed, summarizing all evidences concerning the perinatal outcome of women with infertility and reproductive disorders and the potential mechanisms that may influence poor pregnancy outcome. RESULTS Reproductive disorders (endometriosis, adenomyosis, polycystic ovary syndrome and uterine fibroids) and unexplained infertility share inflammatory pathways, hormonal aberrations, decidual senescence and vascular abnormalities that may impair pregnancy success through common mechanisms. Either in combination or alone, these disorders results in an increased risk of preterm birth, fetal growth restriction, placental pathologies and hypertensive disorders. Systemic hormonal aberrations, and inflammatory and metabolic factors acting on endometrium, myometrium, cervix and placenta are all associated with an aberrant milieu during implantation and pregnancy, thus contributing to the genesis of obstetric complications. Some of these features have been also described in placentas from ART. CONCLUSIONS Reproductive disorders are common in women of childbearing age and rarely occur in isolation. Inflammatory, endocrine and metabolic mechanisms associated with these disorders are responsible for an increased incidence of obstetric complications. These patients should be recognized as 'high risk' for poor pregnancy outcomes and monitored with specialized follow-up. There is a real need for development of evidence-based recommendations about clinical management and specific obstetric care pathways for the introduction of prompt preventative care measures.
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Affiliation(s)
- Silvia Vannuccini
- Department of Molecular and Developmental Medicine, Obstetrics and Gynecology, University of Siena, Siena, Italy
| | - Vicki L Clifton
- Robinson Research Institute, University of Adelaide, Adelaide, Australia
| | - Ian S Fraser
- Department of Obstetrics and Gynaecology, Center for Women's Health, University of New South Wales, Sydney, Australia
| | - Hugh S Taylor
- Department of Obstetrics, Gynecology and Reproductive Sciences, Yale University, New Haven, CT, USA
| | - Hilary Critchley
- MRC Centre for Reproductive Health, University of Edinburgh, The Queen's Medical Research Institute, Edinburgh, UK
| | - Linda C Giudice
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, 550 16th Street, Floor 7, Box 0132, San Francisco, CA 94143, USA
| | - Felice Petraglia
- Department of Molecular and Developmental Medicine, Obstetrics and Gynecology, University of Siena, Siena, Italy
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Courtoy GE, Donnez J, Marbaix E, Dolmans MM. In vivo mechanisms of uterine myoma volume reduction with ulipristal acetate treatment. Fertil Steril 2015; 104:426-34.e1. [DOI: 10.1016/j.fertnstert.2015.04.025] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2015] [Revised: 03/25/2015] [Accepted: 04/20/2015] [Indexed: 01/22/2023]
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