Adverse obstetric outcomes in pregnant women with uterine fibroids in China: A multicenter survey involving 112,403 deliveries.

Rong Zhao,Changdong Li,Weiyuan Zhang,Yi Chen,Liying Zou,Xin Wang,Guanghui Li,Stefan Gebhardt

doi:10.1371/journal.pone.0187821

Rong Zhao, Changdong Li + Show 6 more

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https://doi.org/10.1371/journal.pone.0187821

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Abstract

ObjectiveTo estimate the association between uterine fibroids and adverse obstetric outcomes.MethodsThis 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.ResultsOf 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]).ConclusionPregnant 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.

Highlights

Uterine fibroids are the most common benign tumors of the female reproductive tract [1]
Pregnant women with uterine fibroids are at increased risk for cesarean delivery, breech presentation and postpartum hemorrhage
Some studies have shown a relationship between uterine fibroids and pregnancy complications, such as preterm birth, premature rupture of membranes (PROM), fetal malpresentation, placental abruption and intrauterine fetal demise [10,11,12]

Summary

Introduction

Uterine fibroids are the most common benign tumors of the female reproductive tract [1]. According to the trimester of assessment and the size threshold used, the prevalence of uterine fibroids among pregnant women ranges from less than 1% to 10.7% [2,3]. As more and more women delay child bearing to later in life, the prevalence of uterine fibroids during pregnancy is likely to increase. The incidence of uterine fibroids increases with age [4]. Some studies have shown a relationship between uterine fibroids and pregnancy complications, such as preterm birth, premature rupture of membranes (PROM), fetal malpresentation, placental abruption and intrauterine fetal demise [10,11,12]. Other studies have reported no increased risks for these adverse obstetric outcomes with uterine fibroids [14]. More recent studies have attempted to clarify these conflicting results by grouping fibroids by size and location [15, 16], but those studies still obtained conflicting results due to their small sample sizes

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