Abstract
Prevalence of uterine leiomyoma among pregnant women is approximately 2% and more common in primipara. Leiomyoma with pregnancies are always at high risk as it may be associated with a number of complications like abortion, preterm labor, premature rupture of membranes (PROM), malpresentation, low lying placenta, intrauterine growth restriction (IUGR) and many others. During labor, dystocia, operative interferences like LUCS and post partum hemorrhage (PPH) are often encountered.
Objective: To evaluate the effects of leiomyoma on the course of pregnancy, labor and mode of delivery.
Materials and Method: The study was a prospective and observational study and carried out in a tertiary care hospital of city Kolkata, West Bengal with ethical approval. The study population included the antenatal mothers who attended antenatal OPD from the first trimester of pregnancy. A total of 102 mothers were taken in the study group as case-control study. Group L (n=51), consist of the pregnant mothers having USG confirmed leiomyoma with pregnancy, considered as case. Leiomyoma size of at least 3cm in diameter was included in the study. Group C (n=51) was the pregnant mothers relatively matched with age, parity and gestational weeks with group L, but without having uterine leiomyoma, served as control.
Results: Major portion of pregnant mothers with leiomyoma belonged to nulliparous group. There was higher percentage of termination of pregnancy before 28 weeks (p<0.05), preterm labor (p<0.05), LUCS (p<0.05), PPH (p<0.05), low birth weight baby (p<0.05) and lower percentage of vaginal delivery (p<0.05) among pregnancy with leiomyoma group (Group- L) compared to pregnancy without leiomyoma group (Group-C).
Conclusion: Uterine leiomyoma may adversely affect the course of pregnancy, labor and mode of delivery.
Keywords: Leiomyoma, Preterm labor, PROM, Malpresentation, IUGR, LUCS, PPH.
References
- Qidwai II, Caughey AB,Jacoby AF: Obstetric outcomes in women with sonographically identified uterine leiomyomata. Obstet Gynecol 107:376,2006.
- Stout MJ, Odibo AO, Graseck AS, et al: Leiomyomas at routine second trimester ultrasound examination and adverse obstetric outcomes. Obstet Gynecol 116(5):1056, 2010.
- Laughlin SK, Baird DD, Savitz DA et al: Prevalence of uterine leiomyomas in the first trimester of pregnancy: an ultrasound screening study. Obstet Gynecol 113(3):630,2009.
- Neiger R, Sonek JD, Croom CS, et al: Pregnancy related changes in the size of uterine leiomyomas. J Reprod Med 51:671,2006.
- Salvador E, Bienstock J, Blakemore KJ, et al: Leiomyomata uteri, genetic amniocentesis, and the risk of second trimester spontaneous abortion. Am J Obstet Gynecol 186:913,2002.
- Klatsky PC, Tran ND, Caughey AB, et al: Fibroids and reproductive outcomes: a systemic literature review from conception to delivery. Am J Obstet Gynecol 198(4):357, 2008.
- Shavell VI, Thakur M, Sawant A, et al: Adverse obstetric outcomes associated with sonographically identified large uterine fibroids. Fertil Steril 97(1):107, 2012.
- Devis JL, Ray Mazumder S, Hobel CJ, Baley K, Saspo D. Uterine leiomyoma in pregnancy: a prospective study . Obstet Gynecol 1990; 75:41-4.
- Gloria D, Coronado MS, Lynn M, Marshall SC et al: Complications in pregnancy, labor and delivery with uterine leiomyomas; Obstet Gynecol:95(5),764-69, 2000.
- Parazzini F, La Vecchia C, Negri E et al: Epidemiologic characteristics of women with uterine fibroids: A case control study. Obstet Gynecol, 1989;74:707-09.
- Katz VL, Dotters DJ, Droejemeuller W. Complications of uterine leiomyomas in pregnancy. Obstet Gynecol. 1989;73:593-96.
- Vergani P, Ghidini A, Strobelt N, Roneaglia N, Locatelli A, Lapinski RH, MangioniC. Do uterine leiomyomas influence pregnancy outcome? Am J Perinatal1994; 11: 356-58.
- G Iram Qidwai, Aaron B, Coughey and Alison F Jacoby. Obstetric outcomes in women with sonographically identified uterine leiomyomata: Obstet Gynecol 2006;107:376-82.
- Benson CV, Chow JS, Chang Lee W, Hill JA III, Doubilet PM. Outcome of pregnancies in women with uterine leiomyomas identified by sonography in its first trimester. J Clin Ultrasound 01 Jun 2001: 29 (5): 261-64.
- Vollenhoven BJ, Lawrence AS, Healey DL 1990. Uterine fibroids: A clinical review Br J Obstet Gynecol; 97: 285-98.
- Shailesh Kore, Anahita Panhole, Aparna Hegde, Sangeeta Kulkarni, Miti Ahuja, VR Ambiya. Pregnancy with fibroid. J Obstet Gynecol Ind 54(4):July/August 2004: 361-62.
- Katz VL, Dotters DJ, Droegemeuller W. Complications of uterine leiomyomas in pregnancy. Obstet Gynecol 1989;73:593-96.
Corresponding Author
Sanghamitra Dasgupta
Msc Nursing, Senior Sister Tutor, RGK Medical College, West Bengal, India