Influence of Uterine Myomas on Course and Outcome of Pregnancy

Abstract

Purpose and Introduction: Uterine myomas are present in 1.4 % of all pregnancies. They increase incidence of spontaneous abortions, preterm labor and fetal malpresentation, as well as degeneration and infection of myomas. Some of them must be operated and removed before or during the pregnancy and during the cesarean section. Our study shows how uterine myomas influence the course of pregnancy or the way of its termination. We paid special attention to the group of patients who previously had myomectomy. We seeked for an answer if myomectomy should be an indication for operative delivery or not. Materials and Method: We analyzed 122 pregnancies which were followed and terminated in the Institute for Gynecology and Obstetrics in two years' interval. The patients were divided in 3 groups. Group 1: 23 patients who previously had myomectomy and had normal ultrasound finding during the actual pregnancy. Group 2: 10 patients who previously had myomectomy and had new myomas. Group 3: 89 patients who had one or more myomas and had no operations before. Results and Discussion: Vaginal delivery was performed in 23.7 % cases, they were all spontaneous. Operative deliveries were performed in 76.3 % pregnancies. In group 1 this percentage was 87 % and in group 2 even 90 % due to previous myomectomy. During the cesarean section we performed myomectomy in 33.6 %. There were no significant intrapartal or postpartal hemorrhages. In group 2 we found 2 incomplete uterus ruptures during the elective cesarean sections. Conclusion: We suggest to take special care of patients with previous myomectomy and new myomas because they are at great risk to develop uterine rupture in pregnancy and labor with great danger for fetus and mother.