Pregnancy and labor in patients with uterine fibroid

Uterine fibroid is benign monoclonal tumor which develops from smooth muscle cells of myometrium [1, p.7]. It is the most common benign pelvic tumor in women of reproductive age [5, p.56]. If pregnant woman has uterine fibroid, this creates risks for pregnancy and fetal development [3, p.74].

Purpose. We wanted to assess the features of pregnancy and labor in women with uterine fibroid.

Materials and methods. Aretrospective analysis of medical records was carried out in 61 patients diagnosed with uterine fibroid. All women were observed in the maternity department of the medical unit № 9 in Perm in 2015 year.

Results and discussion. The age of women was from 22 to 46 years. Median age of the patients was 35 years. The proportion of women of late reproductive age was 57 % (35 women). It is important that the age of women is one of the risk factors for the development of uterine fibroid. Uterine fibroid is rare in women under 30 years. The risk of this disease increases after 40 years. Uterine fibroid observed in 70 % cases to 50 years [1, p.8].

Women with first birth were 43 % (26 women), women with second birth were 44 % (27 women). A large number of first-born women (43 %) among women with uterine fibroid is an important indicator, because birth history is a protective factor from the development of uterine fibroid [1, p.8].

Half of the patients had a history of abortion — 48 % (29 women) (tab.1).

Table 1

Number of abortions in history

Genital diseases of inflammatory and non-inflammatory nature were observed in 82 % of patients (49 women) before pregnancy. Half of the women had cervical erosion — 48 % (29 women). Chronic adnexitis was observed in 18 % cases (11 women). Endometritis was in 13 % (8 women). Genital diseases of inflammatory and non-inflammatory nature were observed in 82 % of patients (49 people) before pregnancy. half of the women had cervical erosion — 48 % (29 people). Chronic adnexitis was observed in 18 % of cases (11 people). Endometritis was in 13 % (8 people). Human papillomavirus carriage was in 8 % (5 women) of cases. The uterine polyp was in 8 % (5 women) of cases, too.

Table 2

Extragenital diseases before pregnancy

Characteristics of uterine fibroid.

Single uterine fibroid was found in most cases — 68 % (36 women). In 32 % (17 women) was multiple uterine fibroid, which includes 2 and more nodes.

Myomatous nodes are classified by size as small, medium and large. Half of the subjects — 49 % (26 women) — had medium-sized nodes.

There are 5 types of location of uterine fibroid: the uterine fundus, the anterior and posterior wall of the uterus, the cervix of the uterus, intraligamentary localization. Muomatous nodes were on the anterior wall of the uterus in 57 % (27 women), the nodes on the posterior wall and fundus of the uterus were also observed.

2/3 of women (70 %) had cesarean section. It should be noted, that in 63 % of cases (27 women) was an emergency cesarean section, in 37 % was a planned cesarean section.

Indications for emergency cesarean section is an obstetric pathology, such as:

– immature type of cervix uteri,

– weakness of labor and the lack of effect of drugs to induce labor,

– preeclampsia etc.

Premature labor was in 13 % (8 women).

During cesarean section half of women (56 %) performed myomectomy and diagnosed with subserosal fibroid uterine and mixed types. Increased blood loss in women with myomectomy was in 42 % (10 women) of cases.

Conclusion:

1) The proportion of women of late reproductive age was 57 % (35 women). This fact is important because the risk of uterine fibroid increases at this age [2, p.15].

2) Most women were with first (43 %) and second (44 %) birth. Half of the patients had a history of abortion — 48 %.

3) More than 80 % of patients had genital and extragenital pathology before pregnancy. Among genital pathology the main place was occupied by erosion of the cervix uteri — 48 %. Among extragenital pathology, gastrointestinal diseases were in 33 % of cases and sensory organs in 31 %.

4) Single uterine fibroid was diagnosed in 68 % of cases. Most common uterine fibroids were medium size — 49 %. The main localization of myomatous nodes was in the anterior uterine wall (57 % of cases).

5) Cesarean section was in 70 % of women, because, according to modern foreign sources [4, p.61], women with uterine myoma showed cesarean section in 48 % of cases. Half of the women (56 %) underwent myomectomy during cesarean section. it was determined that myomectomy and increased blood loss in childbirth are associated. almost half of the women with myomectomy had increased blood loss.

References:

1. Davydov A. I., Belotsercovtceva L. D., Chochaeva E. M. Uterine fibroid management: from the past to the present (Jacques Donnez and Marie-Madeleine Dolmans, 22.11.2016). Reality, perspectives, comments. Vopr. ginecol. akus. Perinatal (Gynecology, Obstetrics and Perinatology). 2017; 16(1): 7–17.
2. Pestrikova T. Yu., Yurasova E. A., Yurasov I. V., Chirkov A. V. Rational choice of tactics in patients with uterine fibroids. Literature review. Gynecology. 2017; 19(5): 15–19.
3. Podzolkova N. M., Korennaia V. V., Agisheva V. V. Developing of short term pregnancy in patients with submucosal hysteromyoma (clinical observation). Gynecology. 2016; 18(4): 74–76.
4. Tatarchuk T. P., Kosei N. V., Tutchenko T. N. Uterine fibroids and reproductive function: critical evaluation of therapeutic approaches. Literature review. Reproductive endocrinology. 2011; № 1: 56–63.
5. Tichomirov A. L. Empowering organ-preserving treatment of uterine fibroids using ulipristal acetate. Gynecology. 2016; 18(1): 56–60.