Perinatal complications of pregnancies complicated by uterine fibroids

Fibroids (myomas) are the most common tumors of the female reproductive organs, consisting of smooth muscle cells, fibroblasts, and extracellular matrix. They develop from menarche to menopause. They are diagnosed in 10-20% women of reproductive age. Their size varies from barely visible nodules to large tumors. Change in the size of fibroids during pregnancy and after childbirth is the subject of numerous studies. Most studies indicate a significant increase in the size of fibroids during the first trimester, unchanged size during the second and the third trimester, and a decrease in their size after the delivery. The effect of fibroids on pregnancy depends on their number, location, and size. Myomas are associated with numerous perinatal complications: bleeding in pregnancy, miscarriages, pain due to red degeneration, preterm birth, placental abruption, placenta previa, intrauterine growth restriction, fetal malpresentation, prolonged labor, increased cesarean section rate, uterine atony, and postpartum hemorrhage. Treatment of fibroids in pregnancy includes bed rest and follow-up with symp-tomatic therapy in case of pain, as well as intensive monitoring of the fetus. Very rarely, myomectomy may be necessary during pregnancy. Myomectomy during cesarean section has been considered contraindicated for years. Recent research demonstrates that this procedure may not be associated with an increased risk of perioperative complications. Its advantages include performing two operations within one surgical procedure while avoiding the risks of repeated laparotomy and anesthesia. The most common postpartum complications of fibroids are bleeding and infection.

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Myomectomy during cesarean section

Serbian Journal of Anesthesia and Intensive Therapy ◽

10.5937/sjait2104073s ◽

2021 ◽

Vol 43 (3-4) ◽

pp. 73-80

Author(s):

Radmila Sparić ◽

Đina Tomašević ◽

Mladen Anđić ◽

Miljan Pupovac ◽

Aleksandra Pavić ◽

...

Keyword(s):

Caesarean Section ◽

Cesarean Section ◽

Perioperative Complications ◽

Uterine Fibroids ◽

Surgical Site Infections ◽

Reproductive Age ◽

Benign Tumors ◽

Uterine Torsion ◽

Perioperative Bleeding ◽

Increased Risk

Myomas (fibroids, leiomyomas) are the most common benign tumors of genital organs in women of reproductive age and represent a significant problem in women's health care. The frequency of cesarean section is higher in women with uterine fibroids. Absolute indications for myomectomy during caesarean section are: fibroids that prevent hysterotomy during caesarean section, impede uterine incision suture, hamper safe fetal extraction and cause uterine torsion. Relative indications for myomectomy during caesarean section are: subserous and pedunculated fibroids, anterior uterine wall fibroids, fibroids that can cause immediate perioperative, and puerperal complications, the patient's desire, fibroids that can cause complications in subsequent pregnancies, and fibroids that can be enucleated without additional hysterotomy. Myomectomy during caesarean section is a complex surgical procedure, associated with the possibility of considerable complications, and defining their actual frequency and risk factors for their occurrence requires further research. Myomectomy during caesarean section is associated with an increased risk of perioperative bleeding. Other perioperative complications of myomectomy during cesarean section are: disseminated intravascular coagulation, paralytic ileus, surgical site infections, sepsis, postoperative febrile morbidity, increased incidence of blood transfusions, and prolonged hospitalization.

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Endometriosis and Risk of Adverse Pregnancy Outcome: A Systematic Review and Meta-Analysis

Journal of Clinical Medicine ◽

10.3390/jcm10040667 ◽

2021 ◽

Vol 10 (4) ◽

pp. 667

Author(s):

Kjerstine Breintoft ◽

Regitze Pinnerup ◽

Tine Brink Henriksen ◽

Dorte Rytter ◽

Niels Uldbjerg ◽

...

Keyword(s):

Preterm Birth ◽

Cesarean Section ◽

Placental Abruption ◽

Gestational Hypertension ◽

Adverse Pregnancy Outcome ◽

Placenta Previa ◽

Meta Analysis ◽

Increased Risk ◽

Spontaneous Hemoperitoneum ◽

In Pregnancy

Background: This systematic review and meta-analysis summarizes the evidence for the association between endometriosis and adverse pregnancy outcome, including gestational hypertension, pre-eclampsia, low birth weight, and small for gestational age, preterm birth, placenta previa, placental abruption, cesarean section, stillbirth, postpartum hemorrhage, spontaneous hemoperitoneum in pregnancy, and spontaneous bowel perforation in pregnancy. Methods: We performed the literature review in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA), by searches in PubMed and EMBASE, until 1 November 2020 (PROSPERO ID CRD42020213999). We included peer-reviewed observational cohort studies and case-control studies and scored them according to the Newcastle–Ottawa Scale, to assess the risk of bias and confounding. Results: 39 studies were included. Women with endometriosis had an increased risk of gestational hypertension, pre-eclampsia, preterm birth, placenta previa, placental abruption, cesarean section, and stillbirth, compared to women without endometriosis. These results remained unchanged in sub-analyses, including studies on spontaneous pregnancies only. Spontaneous hemoperitoneum in pregnancy and bowel perforation seemed to be associated with endometriosis; however, the studies were few and did not meet the inclusion criteria. Conclusions: The literature shows that endometriosis is associated with an increased risk of gestational hypertension, pre-eclampsia, preterm birth, placenta previa, placental abruption, cesarean section, and stillbirth.

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Pregnancy management in patients with uterine fibroids. Case report

GYNECOLOGY ◽

10.26442/20795696.2021.5.200777 ◽

2021 ◽

Vol 23 (5) ◽

pp. 448-453

Author(s):

Iuliia E. Dobrokhotova ◽

Sonia Zh. Danelian ◽

Ekaterina I. Borovkova ◽

Elena A. Nagaitseva ◽

Dzhamilia Kh. Sarakhova ◽

...

Keyword(s):

Cesarean Section ◽

Uterine Fibroids ◽

Uterine Cavity ◽

Pain Syndrome ◽

First Trimester ◽

Reproductive Age ◽

Node Degree ◽

Birth Canal ◽

Large Size ◽

Natural Birth

Uterine fibroids (UF) are the most common tumor in women of reproductive age. The growth of myomatous nodes during pregnancy is non-linear and mainly occurs in the first trimester. In most cases, UF do not burden the course of pregnancy. Large size (5 cm), retroplacental location, and/or deformity of the uterine cavity by the myomatous node are associated with increased risks of spontaneous miscarriage, placental abruption, bleeding, preterm birth, and cesarean section. Myomectomy during pregnancy is undesirable, with the development of pain syndrome, the use of acetaminophen is safe. Indications for cesarean section in UF are the presence of a large size of fibroids that prevent delivery through the natural birth canal, red degeneration of myomatous nodes, torsion of the subserous myomatous node (degree 2C).

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Uterine myomas in pregnancy, childbirth and puerperium

Srpski arhiv za celokupno lekarstvo ◽

10.2298/sarh1402118s ◽

2014 ◽

Vol 142 (1-2) ◽

pp. 118-124 ◽

Cited By ~ 15

Author(s):

Radmila Sparic

Keyword(s):

Assisted Reproductive Technologies ◽

Reproductive Function ◽

Neonatal Morbidity ◽

Bed Rest ◽

Reproductive Technologies ◽

Reproductive Age ◽

Benign Tumors ◽

Symptomatic Therapy ◽

Perinatal Complications ◽

In Pregnancy

Fibroids are the most common benign tumors of the genital organs of women in reproductive age. Achieving reproductive function later in life, with more frequent use of assisted reproductive technologies, leads to an increased number of pregnancies complicated with fibroids. Their size may change during pregnancy, but the changes are mostly individual. Most fibroids stop growing or decline during the puerperium. The effect of fibroids on pregnancy depends on their number, size and location. The mechanisms bringing about perinatal complications are not fully understood. Fibroids during pregnancy can cause many perinatal complications, such as bleeding in pregnancy, miscarriage, pain due to red degeneration, malpresentation, preterm labor, premature rupture of membranes, placental abruption and obstruction of delivery and are associated with higher incidence of cesarean section, operative vaginal delivery, uterine atony and postpartum hemorrhage. Postpartum hysterectomy in these women is also more likely than in general population. Postpartum infections are more common in patients with fibroids, and myomas may also cause retained placenta. The most common cause of neonatal morbidity is prematurity, due to pregnancy ending in an earlier gestational age. Monitoring of pregnancies complicated with fibroids is essentially indistinguishable from monitoring normal pregnancies. Therapy includes only bed rest and observation, symptomatic therapy in case of pain and intensive fetal surveillance, and surgery in the acute situations.

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TO THE QUESTION ON UTERINE FIBROIDS DURING PREGNANCY

Scientific digest of association of obstetricians and gynecologists of Ukraine ◽

10.35278/2664-0767.1(47).2021.242698 ◽

2021 ◽

pp. 54-59

Author(s):

T. F. TATARCHUK ◽

N. V. KOSEY ◽

S. I. REGEDA ◽

O. V. ZANKO ◽

K. D. PLAKSIIEVA

Keyword(s):

Statistical Analysis ◽

Cesarean Section ◽

Live Birth ◽

Uterine Fibroid ◽

Postpartum Period ◽

Uterine Fibroids ◽

Premature Delivery ◽

Pelvic Ultrasound ◽

Natural Childbirth ◽

Increased Risk

Uterine fibroids is an extremely common tumor of the female reproductive system, among whose manifestations are infertility, spontaneous abortions, incorrect fetal position, placenta previa, premature delivery, bleeding during and after delivery, and an increased risk of cesarean section. According to the literature, myomas are changing in size during pregnancy and in the postpartum period. Aim of the study. To assess the dynamics of uterine fibroid size change during pregnancy and the effect of an existing uterine fibroid on the course of pregnancy and labor. Materials and methods. Outpatient records of patients aged 24 to 45 years (mean age 33.36 ± 4.63 years) who were diagnosed with Pregnancy and uterine fibroids from 2016 to 2021 at Verum Medical Center were evaluated (n = 57). The size of the fibroids (volume and diameter) before, during (I or II prenatal screening) and after pregnancy (first pelvic ultrasound after delivery) was used for statistical analysis. Forty-one of the 57 patients had pelvic ultrasound before, during, and after pregnancy and were included in the statistical analysis of changes in uterine myoma size. Results. Among the patients included in the statistical analysis, uterine fibroids increased in volume by 194.38% ± 86.9 (40.98% ± 18.4 in diameter) during pregnancy, and decreased by 53.98% ± 14.93 in diameter and by 54.28% ± 29.62 of baseline in the postpartum period. A significant number of fibroids (39.47%) did undergo involutionary changes and were not visualized in the first postpartum ultrasound. The live birth rate was high at 90% (64% of deliveries were through natural childbirth and 26% through cesarean section). Conclusions. There was no effect of intramural, intramural-subserosal, and subserosal uterine fibroids with an average diameter of £20 mm on pregnancy and live birth in women. A great amount of uterine fibroids nearly triple in size during pregnancy, but after delivery they return to their original size and even halve in size. This can be regarded as a confirmation of the absence of a negative effect of pregnancy, or, possibly, a positive effect on uterine fibroid size, which requires further investigation.

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Pregnancy Complications in Women with PCOS

Journal of Gynecology & Reproductive Medicine ◽

10.33140/jgrm.03.05.02 ◽

2019 ◽

Vol 3 (5) ◽

Keyword(s):

Pregnancy Loss ◽

Polycystic Ovarian Syndrome ◽

First Trimester ◽

Reproductive Age ◽

Multiple Pregnancies ◽

Proper Understanding ◽

Life Styles ◽

Reproductive Age Women ◽

Increased Risk ◽

Ovarian Syndrome

The Polycystic ovarian syndrome affects 6-15 % of reproductive age women worldwide. And recently the changing life styles and rising obesity worldwide have contributed to a rise in the incidence of PCOS. Though there are many issues with PCOS post conception. PCOS women are at increased risk of early pregnancy loss which is approx. three fold as compared to the women without PCOS. After successfully crossing the first trimester, they are at risk of developing pre- eclampsia, GDM, preterm birth and birth of small for gestational age infant. Also higher incidence of multiple pregnancies is there and the risks associated with them. All these leading to higher rate of c -section delivery. So, proper understanding of these risks, informing and counseling the patients regarding them facilitate closer maternal and fetal surveillance and help improving the outcome of pregnancy.

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Topiramate use early in pregnancy and the risk of oral clefts

Neurology ◽

10.1212/wnl.0000000000004857 ◽

2017 ◽

Vol 90 (4) ◽

pp. e342-e351 ◽

Cited By ~ 21

Author(s):

Sonia Hernandez-Diaz ◽

Krista F. Huybrechts ◽

Rishi J. Desai ◽

Jacqueline M. Cohen ◽

Helen Mogun ◽

...

Keyword(s):

Linear Models ◽

Reference Group ◽

First Trimester ◽

Population Based ◽

Oral Clefts ◽

Born Infant ◽

Increased Risk ◽

The Us ◽

Median Daily Dose ◽

In Pregnancy

ObjectiveTo assess the relative risk of oral clefts associated with maternal use of high and low doses of topiramate during the first trimester for epilepsy and nonepilepsy indications.MethodsThis population-based study nested in the US 2000–2010 Medicaid Analytic eXtract included a cohort of 1,360,101 pregnant women with a live-born infant enrolled in Medicaid from 3 months before conception through 1 month after delivery. Oral clefts were defined as the presence of a recorded diagnosis in claims during the first 90 days after birth. Women with a topiramate dispensing during the first trimester were compared with those without any dispensing and with an active reference group of women with a lamotrigine dispensing during the first trimester. Risk ratios (RRs) were estimated with generalized linear models with fine stratification on the propensity score of treatment to control for potential confounders. Stratified analyses by indication of use and dose were conducted.ResultsThe risk of oral clefts at birth was 4.1 per 1,000 in the 2,425 infants born to women exposed to topiramate compared with 1.1 per 1,000 in the unexposed group (RR 2.90, 95% confidence interval [CI] 1.56–5.40). The RR among women with epilepsy was 8.30 (95% CI 2.65–26.07); among women with other indications such as bipolar disorder, it was 1.45 (95% CI 0.54–3.86). The median daily dose for the first prescription filled during the first trimester was 200 mg for women with epilepsy and 100 mg for women without epilepsy. For topiramate monotherapy, the RR for oral clefts associated with doses ≤100 mg was 1.64 (95% CI 0.53–5.07) and for doses >100 mg it was 5.16 (95% CI 1.94–13.73). Results were similar when lamotrigine was used as a reference group.ConclusionThe increased risk of oral clefts associated with use of topiramate early in pregnancy was more pronounced in women with epilepsy, who used higher doses.

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Acute HIV Infection in Pregnancy: The Case for Third Trimester Rescreening

Case Reports in Infectious Diseases ◽

10.1155/2011/340817 ◽

2011 ◽

Vol 2011 ◽

pp. 1-5

Author(s):

Jocelyn Wertz ◽

Jason Cesario ◽

Jennifer Sackrison ◽

Sean Kim ◽

Chi Dola

Keyword(s):

Viral Load ◽

Hiv Infection ◽

Late Pregnancy ◽

First Trimester ◽

Acute Hiv Infection ◽

Hiv Rna ◽

Increased Risk ◽

Acute Hiv ◽

Anti Hiv ◽

In Pregnancy

Combination testing with anti-HIV Elisa and Western blot is both sensitive and specific for diagnosis of established HIV-1 infection but could not detect acute HIV infection (AHI). AHI is a time of extremely high viral load, which may correlate to increased risk of horizontal or vertical transmission. Thus, early identification of AHI could allow for interventions to decrease transmission. However, recognition of AHI can be challenging as symptoms could be absent or nonspecific, therefore, AHI is often not detected, particularly in pregnancy. We present a case report of AHI in a pregnant woman who presented with headache and fever. She tested negative for HIV in the first trimester and at time of AHI at 26 3/7 weeks by anti-HIV Elisa, but was diagnosed with AHI based on an HIV RNA viral load of 434,000 copies/mL. This report presents a case for improved awareness of AHI in pregnancy, and the need for repeat HIV testing in late pregnancy, and highlighted that early detection of AHI might be possible with adding HIV RNA testing at time of standard anti-HIV Elisa screening test in pregnancy. Novel laboratory approaches including pooling of sera for HIV RNA could reduce the cost of HIV RNA testing.

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Myomas and Adenomyosis: Impact on Reproductive Outcome

BioMed Research International ◽

10.1155/2017/5926470 ◽

2017 ◽

Vol 2017 ◽

pp. 1-14 ◽

Cited By ~ 15

Author(s):

Nikos F. Vlahos ◽

Theodoros D. Theodoridis ◽

George A. Partsinevelos

Keyword(s):

Preterm Birth ◽

Postpartum Hemorrhage ◽

Placenta Previa ◽

Reproductive Age ◽

Current Evidence ◽

Reproductive Outcome ◽

Increased Risk ◽

Structural Abnormalities ◽

Adverse Pregnancy ◽

The Impact

Among uterine structural abnormalities, myomas and adenomyosis represent two distinct, though frequently coexistent entities, with a remarkable prevalence in women of reproductive age. Various mechanisms have been proposed to explain the impact of each of them on reproductive outcome. In respect to myomas, current evidence implies that submucosal ones have an adverse effect on conception and early pregnancy. A similar effect yet is not quite clear and has been suggested for intramural myomas. Still, it seems reasonable that intramural myomas greater than 4 cm in diameter may negatively impair reproductive outcome. On the contrary, subserosal myomas do not seem to have a significant impact, if any, on reproduction. The presence of submucosal and/or large intramural myomas has also been linked to adverse pregnancy outcomes. In particular increased risk for miscarriage, fetal malpresentation, placenta previa, preterm birth, placenta abruption, postpartum hemorrhage, and cesarean section has been reported. With regard to adenomyosis, besides the tentative coexistence of adenomyosis and infertility, to date a causal relationship among these conditions has not been fully confirmed. Preterm birth and preterm premature rupture of membranes, uterine rupture, postpartum hemorrhage due to uterine atony, and ectopic pregnancy have all been reported in association with adenomyosis. Further research on the impact of adenomyosis on reproductive outcome is welcome.

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A cross sectional observational study to evaluate the maternal and fetal outcome in postdated pregnancies

International Journal of Reproduction Contraception Obstetrics and Gynecology ◽

10.18203/2320-1770.ijrcog20205762 ◽

2020 ◽

Vol 10 (1) ◽

pp. 159

Author(s):

Ritika Narayan ◽

Sheela S. R.

Keyword(s):

Observational Study ◽

Cesarean Section ◽

Tertiary Care ◽

Significant Risk ◽

Fetal Distress ◽

Perinatal Complications ◽

Tertiary Care Centre ◽

Maternal Complications ◽

Cross Sectional ◽

Increased Risk

Background: Post-dated pregnancy is when the gestation is more than 40 weeks or 280 days. They last longer than the estimated date of delivery. Postdated pregnancies are associated with increased perinatal and maternal complications. These risks are greater than it was originally thought. Risks have been underestimated in the past leading to increasing number of complicated postdated pregnancies which appears to be otherwise low risk. The maternal risks are very often underappreciated resulting in increased maternal morbidity.Methods: This cross sectional observational study was done to evaluate maternal and fetal complications associated with Postdated pregnancies was carried out in the department of obstetrics and gynecology in a tertiary care centre, Sir Devraj Urs Medical College and RL Jalappa Hospital, Kolar between July 2018 and July 2019, fulfilling all the inclusion and exclusion criteria.Results: 50 out of 100 patients had full term normal deliveries where as 45% patients required cesarean section. Most common indication for cesarean section was meconium stained liquor with fetal distress (25%). 42% of the babies born needed NICU admission. Most common maternal complication seen was Postpartum Hemorrhage.Conclusions: The present study we conclude that postdated pregnancy was associated with significant risk of perinatal complications such as fetal distress, meconium aspiration syndrome and IUGR. There was increased risk of obstetric complications as well like atonic PPH, oligohydramnios, obstructed labor.

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