Characteristics Of Fibroids Research Articles

The characteristics of a fibroid in pregnancy can influence the perinatal outcome.

To determine whether fibroids affect perinatal outcomes and whether women who undergo fibroid surgery before pregnancy have better perinatal outcomes than those who have fibroids during pregnancy. The study also analyzes the optimal time interval between myomectomy and pregnancy and the characteristics of fibroids during pregnancy that affect perinatal outcomes. In both groups, fibroids' size, number, and location were analyzed to determine their influence on perinatal outcomes. The perinatal outcome is determined by gestational age, birth weight, Apgar score, intrauterine growth retardation, placental complications, and delivery method. A study was conducted on the perinatal outcomes of 338 women who had uterine fibroids during pregnancy and those who had undergone fibroid surgery before pregnancy. The medical records of women who gave birth at a tertiary university hospital were analyzed in this retrospective study. Women with submucosal fibroids have a lower gestational age of delivery (P = 0.0371), and those who operated on a higher number of fibroids before pregnancy had newborns with lower birth weights (P < 0.0001). Submucosal fibroids during pregnancy increase the chances of cesarean delivery (P = 0.0354). 14% of newborns have an Apgar score of less than seven within the first minute of birth in fibroids larger than 7cm (P < 0.0001). There is a statistically significant difference in the perinatal outcome of newborns depending on the number, size and placement of uterine fibroids in both observed groups.

Impact of uterine artery embolization on ovarian function and pregnancy outcome after uterine-fibroids treatment: A prospective study.

Uterine fibroids are benign tumors that originate from smooth muscle cells of the uterus. It is the most common gynecological disorder, affecting up to 80% of women of reproductive age. Uterine fibroids can cause various symptoms such as abnormal uterine bleeding, pelvic pain, infertility, and pregnancy complications. The treatment options for uterine fibroids include medical therapy, surgical intervention, and minimally invasive techniques. To compare ovarian function of women with uterine fibroids who did or did not undergo uterine artery embolization (UAE). This prospective cohort study enrolled 87 women with symptomatic uterine fibroids who underwent UAE, and 87 women with the same symptoms who did not undergo UAE but received conservative management or other treatments. The two groups were matched for age, body mass index, parity, and baseline characteristics of uterine fibroids. The primary outcome was ovarian function that was evaluated by serum levels of follicle-stimulating hormone (FSH), luteinizing hormone (LH), estradiol (E2), and anti-Müllerian hormone (AMH), as well as ovarian reserve tests, such as antral follicle count (AFC) and ovarian volume (OV). The secondary outcome was fertility that was evaluated based on the menstrual cycle, ovulation, conception, pregnancy, and delivery. The participants were followed-up for 36 months and assessed at 1, 3, 6, 12, 24, and 36 months after treatment. The study found that the most common minor complication of UAE was postembolization syndrome in 73.6% of women, resolving within a week. No significant differences were observed between the UAE group and the control group in serum levels of reproductive hormones (FSH, LH, E2, AMH) and ovarian reserve indicators (AFC, OV) at any point up to 36 months post-treatment. Additionally, there were no significant differences in conception, pregnancy, or delivery rates, with the average time to conception and gestational age at delivery being similar between the two groups. Birth weights were also comparable. Finally, there was no significant correlation between ovarian function, fertility indicators, and the type or amount of embolic agent used or the change in fibroids post-treatment. UAE resulted in significantly positive pregnancy outcomes, no adverse events post-treatment, and is a safe and effective treatment for uterine fibroids that preserves ovarian function and fertility.

Global epidemiological characteristics of uterine fibroids.

The aim of the study was to examine the burden of uterine fibroids at global, regional and national levels in terms of age and the Socio-demographic Index (SDI). Data were extracted from the GBD 2019 dataset. Estimated annual percentage changes (EAPCs) were calculated to assess the incidence of uterine fibroids, and trends in disability-adjusted life years (DALYs) were examined. All measures examined were stratified by region, country, age and SDI to assess the effects of these variables on the incidence of uterine fibroids. The global age-standardized incidence rate of uterine fibroids increased from 1990 to 2019, with an EAPC of 0.25 (95% confidence interval (CI): 0.24 to 0.27). In contrast, the global age-standardized DALY rate decreased from 1990 to 2019, with an EAPC of -0.27 (95% CI: -0.31 to -0.23). High and low-middle SDI regions experienced significantly higher age-standardized incidence rates. Moreover, in 2019, low and low-middle SDI regions had significantly higher age-standardized DALY rates due to uterine fibroids than other SDI regions. Regionally, Eastern Europe had the highest age-standardized incidence rate of uterine fibroids in 2019, and Tropical Latin America experienced the greatest increase in age-standardized incidence rates from 1990 to 2019. Nationally, Brazil (EAPC = 1.46; 95% CI: 1.35-1.57) and India (EAPC = 1.09; 95% CI: 0.94-1.25) experienced the most significant increases in age-standardized uterine fibroid incidence. Age-standardized DALY rates increased the most in Tropical Latin America, high-income North America and Oceania. Globally, the age-standardized incidence of uterine fibroids has been increasing in recent years. In contrast, age-standardized DALY rates have exhibited a decreasing trend. Eastern Europe, Tropical Latin America, Brazil and India experience the greatest uterine fibroid burden. Globally, women aged 35-39 years and older have an increased risk of uterine fibroids, as reflected in the higher incidence rates among these age groups.

Evaluate the effectiveness of laparoscopic myomectomy without power morcellator

Aim: To describe characteristics of uterine fibroids and evaluate the effectiveness of laparoscopic myomectomy.&#x0D; Methods: Cross-sectional observative study in fifty-two patients underwent laparoscopic myomectomy at Department of Obstetrics and Gynecology, Hospital of Hue Medicine and Pharmacy University and Hue Central Hospital from 6/2019 to 6/2021. Inclusion criteria were patients with ≤ 5 fibroids, largest diameter did not exceed 10cm in diameter and no contraindication for laparoscopy. Patients were operated laparoscopically and manually morcellated by vaginal route, without electrical morcellator.&#x0D; Results: Mean age was 42.3 ± 4.2 years old. The most common symptom was abnormal uterine bleeding (42.3%). The mean diameter was 66.8 ± 16.3 mm. The success rate of laparoscopic myomectomy was 98.1%. The mean operation time was 148.66 ± 51.4 min. Diameter ≥ 80mm, multiple fibroids (&gt;5 fibroids) and operation time ≥ 180 min (p &lt; 0.05) were associated factors of significant Hemoglobin drop and prolonged surgery.&#x0D; Conclusions: Laparoscopic myomectomy had high success rate and low complication rate, however appropriate indication and experienced surgeon were necessary.

Assessment of adverse pregnancy outcomes in women presenting with uterine fibroids at a tertiary care hospital.

Objective: To determine frequency of adverse pregnancy outcomes in women presenting with uterine fibroids at a tertiary care hospital. Study Design: Descriptive Case Series. Setting: Department of Obstetrics &amp; Gynaecology, Nishtar Hospital, Multan. Period: 25th November 2020 to 24th June 2021. Material &amp; Methods: The detailed history was taken and patients were examined thoroughly. Data was collected for basic demographics i.e. Age, parity, BMI, duration of complaints and pregnancy outcomes. Patients were booked and followed up for the pregnancy outcomes like preterm labour and post-partum hemorrhage. Results: Mean age of our study cases was noted to be 28.98 ± 3.68 years. Mean duration of fibroids was noted to be 26.46 ± 8.11 months and most of them i.e. 86 (53.8%) presented with duration of disease for more than 2 years. Mean body mass index of our study cases was noted to be 26.21 ± 2.14 kg/m2 and obesity was present in 47 (29.4 %) of our study cases. Mean gestational age was noted to be 37.11 ± 3.09 weeks and 100 (62.4%) had gestational age more than 34 weeks. Large fibroids were observed in 21 (13.1 %), small in 48 (30 %), single fibroids in 39 (24.4 %), multiple fibroids in 39 (24.4 %), intramural in 7 (4.4%) and submucosal in 6 (3.8%). Preterm labor was noted in 88 (55 %) and Postpartum hemorrhage was noted in 66 (41.3 %) of our study cases. Conclusion: Uterine fibroids are associated with significantly increased adverse pregnancy outcomes as the frequencies of preterm births and postpartum hemorrhage were very high in our study. Preterm births were significantly associated with age, parity, obesity and characteristics of fibroids. Postpartum hemorrhage was significantly associated with age, parity, residential status, obesity and characteristics of fibroids.

Impact of uterine fibroid surgery on lower urinary tract symptoms

ObjectiveUterine fibroids are often associated with lower urinary tract symptoms (LUTS), the exact prevalence of which has been underexplored. Our main objective was to evaluate the effect of surgical treatment of fibroids on LUTS. Our secondary objectives were to assess the prevalence of LUTS in women undergoing fibroid surgery and to analyze the relationship between the characteristics of fibroids and the severity of symptoms. MethodsThis was a prospective study of women conducted between 2019 and 2021. The main endpoint was the change in the total UDI-6, IIQ7, ICIQ-SF and CONTILIFE scores preoperatively and 6 weeks postoperatively. ResultsOf the 55 included women, 63.6% had frequency and 60% had urgency. Six weeks postoperatively, urinary symptoms had significantly improved for all scores. The presence of an anterior fibroid was significantly associated with higher urinary symptom scores for the UDI-6 (p = 0.007) and ICIQ-SF scores (p = 0.04). The size of the uterus or dominant fibroid was not significantly associated with the severity of urinary symptoms. ConclusionFibroids are often associated with symptoms of overactive bladder. An anterior location of the fibroid appears to be associated with greater severity scores. Surgical treatment appears to reduce urinary symptoms 6 weeks postoperatively.

Factors influencing intraoperative blood loss and hemoglobin drop during laparoscopic myomectomy: a tailored approach is possible?

A retrospective study was conducted on patients subjected to laparoscopic myomectomy at our institution from January 2017 to December 2018 to identify predictive factors of blood loss. Two multiple regression models were run to predict intraoperative blood loss and haemoglobin drop. Predictors of an increased intraoperative blood loss and haemoglobin drop were the presence of three-four fibroids at ultrasound (+47 ml, p = .01; +0.58 g/dl, p = .05) and increased operative time (r = 0.57, p = .01; r = 0.01, p < .01), while predictors of a reduced intraoperative blood loss and haemoglobin drop were epinephrine injection (–50 ml, p < .01; −0.42 g/dl, p < .01), FIGO7 (–87 ml, p < .01; −0.85, p = .01), and FIGO6 (–35 ml, p < .01; −0.44, p = .02) fibroids at the ultrasound. Preoperative ultrasound evaluation is crucial in identifying patients at higher risk for blood loss, which could benefit from optimising haemoglobin values. The injection of diluted epinephrine could be proposed in selected high-risk patients. In the clinical practice, a tailored approach based on fibroids’ ultrasonographic characteristics should be implemented to optimise preoperative Hb values and evaluate the use of diluted epinephrine in selected cases, reducing blood loss and the potential related complications. Impact statement What is already known on this subject? Laparoscopic myomectomy is the conservative surgical treatment of choice for symptomatic uterine fibroids. Still, it could represent a challenging procedure even for an experienced surgeon, with the risk of excessive blood loss, need of transfusions, prolonged operative time, and prolonged hospital stay. The knowledge of the predictive factors of blood loss is essential for patient preparation and surgical planning to reduce intraoperative and postoperative complications. What do the results of this study add? The results of the present study focus on the importance of presurgical evaluation to identify predictive factors of intraoperative blood loss and Hb drop such as the number of fibroids and the FIGO classification (at preoperative ultrasound), as well as intraoperative factors like operative time and the intramyometrial injection of diluted epinephrine. What are the implications of these findings for clinical practice and/or further research? A tailored approach based on the ultrasonographic characteristics of fibroids should be implemented to optimise preoperative haemoblobin levels.

Role of contrast-enhanced ultrasonography in MR-guided focused ultrasound ablation on uterus fibroids: lesion selection and assessment of ablative effects.

To determine whether contrast-enhanced ultrasonography (CEUS) can be used for selecting lesions and assessing the ablative effects of MRgFUS ablation on uterus fibroids, compared with MR imaging. This retrospective study was approved by the institutional review board of our hospital. From April 2018 to November 2019, a total of 44 symptomatic fibroids in 38 patients who underwent MRgFUS ablation were included. The association between pre-ablation characteristics on CEUS/MR imaging and the non-perfusion volume (NPV) after ablation was analyzed using multivariable linearregression analysis. The area under the curve (AUC) of the receiver operating characteristic (ROC) curve values was compared between the CEUS and MR imaging regression models. NPV after ablation was compared between CEUS and enhanced MR imaging. On CEUS, entangled branch vessels, fast-in, and fast-out patterns were significantly associated with NPV, with an AUC of 0.95 (95% CI; 0.88, 1.00). On MR imaging, hyper-intensity on T2-weighted images (T2WI), hyper-intense ring-like signal on T2WI images, and hyper-enhancement on contrast-enhanced T1WI images were correlated with NPV, with an AUC of 0.86 (95% CI; 0.70, 1.00). After ablation, no differences in NPV were noted between contrast-enhanced T1WI (84.13 ± 75.42 cm3) and CEUS (80.22 ± 76.49 cm3). Some pre-ablation characteristics of uterine fibroids on CEUS were associated with NPV after MRgFUS. CEUS may contribute to the evaluation of ablative outcomes and patient selection, similar to MR imaging. • Contrast-enhanced ultrasonography (CEUS) is effective for selecting the appropriate uterine fibroids before MR-guided focused ultrasound (MRgFUS) ablation and evaluating non-perfusion volumes (NPV) after ablation, as a potential alternative to MR imaging. • Before ablation, entangled branch vessels, fast-in, and fast-out patterns on CEUS were significantly associated with NPV after MRgFUS. • No significant differences in NPV were detected between contrast-enhanced T1WI and CEUS after ablation.

Prognostic value of the location of submucosal uterine leiomyomas in infertility.

Submucosal fibroid location and size are predictive factors of impaired fertility. Submucosal fibroids cause infertility through several mechanisms including distortion of the endometrial cavity, increased uterine contractility, local inflammation and remodeling of the endometrial blood supply. This is a monocentric, retrospective, cross-sectional study, conducted in the Department of Obstetrics and Gynecology of 'Sf. Pantelimon' Clinical Emergency Hospital, analyzing patients from a 5-year period (January 2015-December 2019). In the present study, the relationship between different characteristics of the submucosal fibroids (among others, location and dimensions) and fertility (birth rates, early pregnancy loss rates) were investigated. This study identified that submucosal and intramural fibroids are risk factors for reduced birth rate compared with subserosal fibroids (P=0.02, RR=2.58, 95% CI 1.03-6.47; P=0.005, RR=1.18, 95% CI 1.02-1.35, respectively). In addition, G2 leiomyomas are risk factors for low birth rate compared with G0 and G1 fibroids (P=0.01, RR=1.95, 95% CI 1.05-3.60). Moreover, the presence of a subserosal fibroid was associated with an increased early pregnancy loss rate (P=0.01, RR=2.14, 95% CI 1.05-4.35). In conclusion, the location and degree of uterine cavity distortion are important factors that alter the normal development of a pregnancy and the birth rate.

Fibroids as a Risk Factor for Deep Vein Thrombosis (DVT) at an Urban Academic Institution: A Retrospective Observational Study

<h3>Study Objective</h3> To assess if and how fibroids increase the risk of developing a DVT, and review how these patients have been managed. <h3>Design</h3> This retrospective observational study reviews the characteristics of fibroids in patients who have been diagnosed with a DVT. <h3>Setting</h3> Urban academic tertiary-care hospital, single institution. <h3>Patients or Participants</h3> Women ages 18 to 65 years old with a diagnosis of a fibroid uterus who had a thrombotic event from January 1, 2012, to December 31, 2019, were reviewed. ICD-10 codes were used to obtain charts of a total of 1293 patients. Of these, 221 met inclusion criteria and 73 underwent full chart review. Their average BMI was 34.5 and average hemoglobin was 10.2. <h3>Interventions</h3> A retrospective observational chart review was completed to assess how patients with a fibroid uterus who had a thrombotic event were managed and the characteristics of these fibroid uteri. <h3>Measurements and Main Results</h3> 100% of the patients (n=73) were diagnosed with a fibroid uterus and lower extremity DVT and/or pulmonary embolism (PE). 66% (n=48) of these thrombotic events were unprovoked. Of those that were provoked, 32% (n=8) were postoperative after a hysterectomy for symptomatic uterine fibroids. Of those patients diagnosed with a thrombotic event subsequently needing surgery for their fibroids, only 24% (n=4) were able to complete their surgery within the first 3 months of the thrombotic event. Characteristics of fibroids in patients with a thrombotic event were as follows: the mean size of the largest fibroid was 6.3cm; the mean uterine volume was 575cc with 64% of the uteri ranging from 100-700cc; 80% had 5 or fewer fibroids with 16% only having one fibroid. <h3>Conclusion</h3> Fibroid uteri may be an independent risk factor for developing a DVT in women ages 18 to 65 years old. These patients should be risk-stratified and appropriate chemoprophylaxis should be considered in an attempt to prevent thrombotic events.

Incidence, Diagnosis and Treatment of Broad Ligament Fibroids in Women Undergoing Minimally Invasive (MIS) Myomectomy: A Chart Review

<h3>Study Objective</h3> The incidence of broad ligament fibroids is reported to be approximately 1% in the literature, however based on our surgical population, we propose that the incidence is much higher. Broad ligament fibroids are commonly misdiagnosed on preoperative MRI imaging. We aim to determine preoperative imaging characteristics that suggest a diagnosis of broad ligament fibroid. We aim to determine the true incidence of broad ligament fibroids in women undergoing MIS myomectomy at a single institution. <h3>Design</h3> Retrospective chart review was performed to identify preoperative imaging, operative reports, and postoperative data in the acute postoperative period (10 weeks following surgery). <h3>Setting</h3> N/A. <h3>Patients or Participants</h3> Patients were identified for inclusion via review of the surgical schedule during the study period (January 2018 – December 2020). Women ≥18 years-old undergoing MIS myomectomy were eligible for inclusion. 227 patients were identified for inclusion and chart review. <h3>Interventions</h3> N/A. <h3>Measurements and Main Results</h3> A total of 27 (11.9%) patients were identified to have a broad ligament fibroid at the time of surgery. One additional patient was identified in whom the fibroid had significant adhesions to the broad ligament but did not arise from the broad ligament itself. No patients had preoperative imaging correctly identifying the location of the fibroid as within the broad ligament. Complications included pelvic sidewall hematoma (1), thermal colon injury (1), postoperative hypotension (1), incisional hernia (1), readmission for hemoperitoneum (1), reoperation for hemoperitoneum (1), incisional cellulitis (1), and unexpected salpingo-oophorectomy secondary to adhesions (1). <h3>Conclusion</h3> The 11.9% incidence reported here is significantly higher than previously reported. Correct preoperative diagnosis is exceedingly rare, making accurate surgical counseling difficult. A goal of gynecologic imaging should be to identify common characteristics of broad ligament fibroids on MRI imaging because such patients can have increased rates of complications after MIS myomectomy. Accurate imaging and preoperative diagnosis are critical for proper surgical counseling, planning and intraoperative management.

Understanding the Impact of Uterine Fibroids on Human Endometrium Function.

Uterine fibroids (leiomyomas) are the most common benign gynecological tumors in women of reproductive age worldwide. They cause heavy menstrual bleeding, usually leading to severe anemia, pelvic pain/pressure, infertility, and other debilitating morbidities. Fibroids are believed to be monoclonal tumors arising from the myometrium, and recent studies have demonstrated that fibroids actively influence the endometrium globally. Studies suggest a direct relationship between the number of fibroids removed and fertility problems. In this review, our objective was to provide a complete overview of the origin of uterine fibroids and the molecular pathways and processes implicated in their development and growth, which can directly affect the function of a healthy endometrium. One of the most common characteristics of fibroids is the excessive production of extracellular matrix (ECM) components, which contributes to the stiffness and expansion of fibroids. ECM may serve as a reservoir of profibrotic growth factors such as the transforming growth factor β (TGF-β) and a modulator of their availability and actions. Fibroids also elicit mechanotransduction changes that result in decreased uterine wall contractility and increased myometrium rigidity, which affect normal biological uterine functions such as menstrual bleeding, receptivity, and implantation. Changes in the microRNA (miRNA) expression in fibroids and myometrial cells appear to modulate the TGF-β pathways and the expression of regulators of ECM production. Taken together, these findings demonstrate an interaction among the ECM components, TGF-β family signaling, miRNAs, and the endometrial vascular system. Targeting these components will be fundamental to developing novel pharmacotherapies that not only treat uterine fibroids but also restore normal endometrial function.

Pathogenicity of CYP17α mutations in the occurence of uterine fibroids and breast fibroadenomas

Background. Uterine fibroids and breast fibroadenomas are a real public health problem. Despite the efforts made, the etiological factors are still unknown. In addition, these tumors share histopathological similarities, including a higher prevalence in black women. To better understand the factors involved, we set out to assess the genetic characteristics of uterine fibroids and breast fibroadenomas in Senegalese women using CYP17α genes. Results. For the CYP17α gene, 196 mutations were found among which, 65 are specific to uterine fibroids, 112 mutations specific to breast fibroadenomas and 19 common to both pathologies. Analysis of the pathogenicity of missense mutations reveals that many mutations are considered to be a simple polymorphism and 21 non-synonymous mutations appear to be potentially damaging, including 6 specific to patients with uterine fibroids; 14 found in patients with breast fibroadenomas. Conclusion. As a genetic marker of risk, the codons 12, 17, 20, 60 and 72 of CYP17α can be a tool to identify high-risk groups of women for prevention and treatment protocols.

Use of multiparametric MRI to characterize uterine fibroid tissue types.

Although the biological characteristics of uterine fibroids (UF) have implications for therapy choice and effectiveness, there is limited MRI data about these characteristics. Currently, the Funaki classification and Scaled Signal Intensity (SSI) are used to predict treatment outcome but both screening-tools appear to be suboptimal. Therefore, multiparametric and quantitative MRI was studied to evaluate various biological characteristics of UF. 87 patients with UF underwent an MRI-examination. Differences between UF tissues and myometrium were investigated using T2-mapping, Apparent Diffusion Coefficient (ADC) maps with different b-value combinations, contrast-enhanced T1-weighted and T2-weighted imaging. Additionally, the Funaki classification and SSI were calculated. Significant differences between myometrium and UF tissue in T2-mapping (p = 0.001), long-TE ADC low b-values (p = 0.002), ADC all b-values (p < 0.001) and high b-values (p < 0.001) were found. Significant differences between Funaki type 3 versus type 1 and 2 were observed in SSI (p < 0.001) and T2-values (p < 0.001). Significant correlations were found between SSI and T2-mapping (p < 0.001; ρs = 0.82), ADC all b-values (p = 0.004; ρs = 0.31), ADC high b-values (p < 0.001; ρs = 0.44) and long-TE ADC low b-values (p = 0.004; ρs = 0.31). Quantitative MR-data allowed us to distinguish UF tissue from myometrium and to discriminate different UF tissue types and may, therefore, be a useful tool to predict treatment outcome/determine optimal treatment modality.

Differences in the therapeutic effects of high-intensity focused ultrasound (HIFU) ablation on uterine fibroids with different shear wave velocity (SWV): a study of histopathological characteristics

Objective To explore correlations between the therapeutic effect of high intensity focused ultrasound (HIFU) and histopathological characteristics of uterine fibroids with different Shear Wave Velocity (SWV) values. Methods A retrospective study was conducted on 36 women (43 fibroids) who had undergone high intensity focused ultrasound (HIFU) uterine fibroids ablation between January 2019 and January 2020. Preoperative fibroids tissue sections were obtained for histopathological examination. The pathological sections were stained with Masson-trichrome, and were observed and imaged under a Low-power microscope (4 × 10), while the smooth muscle cell (SMC) and collagen fiber content were semi-quantitatively measured. Preoperative fibroid SWV was measured using the Virtual Touch tissue quantification (VTQ) technique. Within one month after HIFU ablation, all patients had undergone a pelvic cavity MRI examination, which measured the size, volume, and non-perfused volume (NPV) of the fibroids. The formula: the ablation rate = NPV/target fibroid volume × 100% was used to calculate the ablation rate of the uterine fibroids. Correlation analysis of SWV values, HIFU ablation rate, along with the smooth muscle cell (SMC) and collagen fiber content, were conducted using the Spearman’s correlation test. Results The collagen fiber and SMC content of the preoperative fibroids were 32.09 ± 15.90%/view and 37.61 ± 15.32%/view, respectively. Preoperative fibroid SWV value was 3.56 ± 0.71 m/s. Preoperative fibroid SWV was negatively correlated with SMC content (r = −0.445, p = 0.003), but positively correlated with collagen fiber content (r = 0.454, p = 0.002). The ablation rate was negatively correlated with collagen fiber content (r = −0.377, p = 0.013), but positively correlated with SMC content (r = 0.402, p = 0.007). Conclusion Differences in histopathological characteristics may be important factors that induce differences in the therapeutic effects of HIFU ablation on uterine fibroids with different SWV values.

The impact of hysteroscopic myomectomy on fertility and pregnancy outcomes of infertile women according characteristics of submucous fibroids

Purpose of investigation: To assess fertility and pregnancy outcomes in infertile patients after hysteroscopic myomectomy according characteristics of submucous fibroids. Materials and Methods: The authors included 56 infertile women, who were diagnosed with a submucous uterine fibroid, and assessed their fertility and pregnancy outcomes after hysteroscopic myomectomy, which was the exposure of interest. The control group consisted of 63 women who underwent a hysteroscopic polypectomy. The submucous fibroid and endometrial polyp were diagnosed preoperatively using 2D ultrasound, and the diagnosis was confirmed during hysteroscopy. All myomectomies and polypectomies were performed using a resectoscope with a bipolar loop electrode. In the first postoperative year, the authors analyzed the rates of pregnancy, spontaneous abortion, preterm and term deliveries, as well as mode of delivery according to type, size, location, and number of submucous fibroids or polyps in each group. Results: In the first postoperative year, pregnancy occurred in 30.4% of patients. The greatest proportion of pregnancies occurred after removal of type 1 submucous fibroids, fibroids &lt; 3 cm, and those localized on the posterior wall of the uterine corpus. Spontaneous abortion occurred in 7.1% of pregnancies, while delivery occurred in 19.6%. Term delivery occurred in 16.1%, while preterm delivery occurred in 3.6%. Vaginal delivery occurred in 14.3% of women, while caesarean section was performed in 5.4% of women. There were not significant differences in rates of pregnancy and delivery according to type, size, and localization of the fibroid or endometrial polyp. Conclusion: For infertile patients, in whom infertility is caused by a submucous fibroid, hysteroscopic myomectomy increases the pregnancy rate, and leads to good reproductive outcomes.

Review of influential clinical factors in reducing the risk of unsuccessful MRI-guided HIFU treatment outcome of uterine fibroids.

Magnetic resonance imaging-guided high-intensity focused ultrasound (MRI-guided HIFU) is an effective noninvasive treatment option for symptomatic uterine fibroids. However, tissue characteristics of uterine fibroids and technical limitations can limit the patient population that can benefit from this therapy. In this article, we present our literature review focusing on the influential clinical factors that might reduce the risk of an unsuccessful MRI-guided HIFU treatment outcome of uterine fibroids.

Ulipristal acetate for uterine fibroids: 2 years of real world experience in a UK hospital

Ulipristal acetate (UPA), is a selective progesterone-receptor modulator, it decreases fibroid size and reduces menstrual bleeding. We reviewed its use at the Heart of England Foundation Trust (HEFT), one of the largest prescribing trusts in the UK. The electronic records of patients treated with UPA from January 2013 to August 2015 were reviewed. One hundred and thirty four patients received UPA, 20 women (15%) received a second course. Eighty percent reported subjective global improvements in symptoms after the first course; 45.5% described amenorrhoea or light bleeding compared to 4.5% prior to treatment. Fewer patients were anaemic (Hb <11 g/dL) following treatment (8.2% versus 33.6%). The majority of fibroids (34%) reduced or remained the same size (25%). Two-thirds of women treated for symptom control avoided surgical intervention. UPA improves symptoms and modifies the use of surgery in treating fibroids. Correcting anaemia prior to major surgery reduces the risk of blood transfusion and optimises a patient’s condition as part of an enhanced recovery pathway.Impact StatementWhat is already known on this subject: In women with heavy menstrual bleeding secondary to fibroids, UPA has been shown to reduce fibroid size and control uterine bleeding, inducing amenorrhoea in the majority. Initially, only licenced for pre-operative use, an expansion of the licence has included on-going intermittent use for symptomatic fibroids.What the results of this study add: Our review is the largest published cohort of women treated with UPA. It demonstrates symptomatic improvements and advantageous modifications in fibroid size in women of all ethnicities and ages. Our inclusion of women with a uterine size greater than 16 weeks and fibroid diameter larger than 10 cm demonstrates the benefits of UPA with increased fibroid dimensions.What the implications are of these findings for clinical practice and/or further research: These findings can allow clinicians to consider alternative surgical interventions or even avoid surgery completely in a proportion of patients with fibroids. Correcting anaemia and optimising a patient’s pre-operative condition reduces post-operative complications and ongoing morbidity. However, 25% of fibroids failed to respond to UPA treatment, further research into the characteristics of women and fibroids that show favourable clinical outcomes will allow identification of those women who are likely to benefit from treatment and prevent futile use in others.

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

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.

Recent Advances in Uterine Fibroid Etiology.

Uterine fibroids, also known as uterine leiomyoma (UL), are monoclonal tumors of the smooth muscle tissue layer (myometrium) of the uterus. Although ULs are considered benign, uterine fibroids are the source of major quality-of-life issues for approximately 25% of all women, who suffer from clinically significant symptoms of UL. Despite the prevalence of UL, there is no treatment option for UL which is long term, cost-effective, and leaves fertility intact. The lack of understanding about the etiology of UL contributes to the scarcity of medical therapies available. Studies have identified an important role for sex steroid hormones in the pathogenesis of UL, and have driven the use of hormonal treatment for fibroids, with mixed results. Dysregulation of cell signaling pathways, miRNA expression, and cytogenetic abnormalities have also been implicated in UL etiology. Recent discoveries on the etiology of UL and the development of relevant genetically modified rodent models of UL have started to revitalize UL research. This review outlines the major characteristics of fibroids; major contributors to UL etiology, including steroid hormones; and available preclinical animal models for UL.