Leiomyomas In Pregnancy Research Articles

"Deciduoid" Change in Uterine Leiomyomas in Pregnancy: Aberrant Expression of Sex Cord Markers Inhibin and Calretinin.

Leiomyomas are common hormone-responsive uterine neoplasms which can exhibit a variety of morphologic changes secondary to hormonal agents such as progestogens. They may increase in size during pregnancy as a result of hormonal stimulation but surprisingly the morphologic features of leiomyomas in pregnancy are not well described in the literature. In this report, we describe the morphologic features of a series of 29 uterine leiomyomas in pregnancy. The features include in decreasing order of frequency infarct-type necrosis, decidualization of the serosal surface, hyalinization, myxoid alteration of the stroma, edema (sometimes with cyst formation), and dystrophic calcification. We also report a feature which we term "deciduoid" change (seen in 10 of 29 leiomyomas) which takes the form of altered smooth muscle cells with an epithelioid morphology with abundant eosinophilic or clear cytoplasm. Furthermore, we show that the "deciduoid" cells commonly exhibit expression of sex cord markers inhibin and calretinin. We speculate on the pathogenesis of the "deciduoid" change which together with its "aberrant" immunophenotype may result in diagnostic problems and consideration of other neoplasms.

Cotyledonoid dissecting leiomyoma in pregnancy: a case report

Cotyledonoid dissecting leiomyoma (CDL) is a rare variant of uterine leiomyoma characterized by intramural dissection within the uterine corpus and a distinctive gross appearance resembling the cotyledons of the placenta. Despite their alarming, sarcomatous appearance both macroscopically and radiographically, these tumors are typically associated with bland histologic findings. Approximately 70 cases of CDL have been described in the literature. This case represents the second described case of CDL in pregnancy, the first in which a pregnancy was carried to term. A 28-year-old primigravid was incidentally found to have a massive, exophytic growth of the uterus on ultrasound with concomitant 14-week intrauterine pregnancy. The pregnancy was monitored with serial growth ultrasounds. She was delivered at 37 weeks via Cesarean section. After being lost to follow-up, the patient presented 2.5 years later with worsening abdominal fullness and persistent uterine mass.

Parasitic Leiomyoma in Pregnancy

Parasitic Leiomyoma in Pregnancy

Leiomyomas in pregnancy

Uterine fibroids are the most common benign tumors affecting female genital tract, responsible for a high morbidity across fertile age women, with a prevalence of 0,1-11% among pregnant women. Although generally asymptomatic, they can lead to a series of symptoms and complications such as pain, infertility, miscarriages, antenatal bleeding, postpartum hemorrhage, preterm labor, fetal malpresentation, placental abruptio and high cesarean section rates. The purpose of review is to update information regarding fibroids specifications and their correlation with pregnancy outcomes as well as fibroids management during pregnancy. Because of uterine fibroids heterogeneity and lack of large, randomized trials there are encountered discrepancies among studies, but it was observed that uterine fibroids increase the risks of negative obstetrical outcomes, especially when it goes to large, multiple, submucous and retroplacental myomas. Conservative management during pregnancy is advised, but in special situations myomectomy could be recommended and possible. Trial of labor should be offered to pregnant women even if they have large uterine fibroids, or previous myomectomy excepting fibroids obstructing the birth canal or patients who underwent extensive surgery for fibroids removal.

Torsion of a Pedunculated Subserous Leiomyoma in a Pregnant Woman: A Rare Case Report

Torsion of a pedunculated subserous leiomyoma in a pregnant woman is a rare condition that requires prompt diagnosis and urgent surgical intervention. In this report, we present a case of torsion of a pedunculated subserous leiomyoma in a primigravid woman aged 33 years in her 30th week of gestation. A primigravid woman aged 33 years presented to our clinic in her 30th week of gestation with pain in the right lower quadrant that had developed in the last 24 hours. Our diagnosis was torsion of a pedunculated leiomyoma. The patient received a tocolytic of nifedipine and indomethacin preoperatively. Given the volume of the uterus and as a precaution to potential complications, a lower transverse (pfannenstiel) incision was preferred. The laparotomic myomectomy was successfully performed and the pregnancy continued uneventfully. Even though torsion of a pedunculated subserous leiomyoma in pregnancy is a very rare condition, prompt diagnosis and urgent surgical intervention is life saving and provides more favorable maternal and fetal outcomes. The surgical approach should be tailored to the patient and to the characteristics of the myoma and an expert team of surgeons and anesthesiologists is essential in order to reduce the risk of complications.

Leiomyomas in Pregnancy and Spontaneous Abortion: A Systematic Review and Meta-analysis.

To systematically review studies reporting the risk of spontaneous abortion among pregnant women of typical reproductive potential with and without uterine leiomyomas. We searched PubMed, EMBASE, Web of Science, and ClinicalTrials.gov for publications from January 1970 to December 2016. We excluded studies that did not use imaging to uniformly document leiomyoma status of all participants, did not have a comparison group without leiomyomas, or primarily included women seeking care for recurrent miscarriage, infertility care, or assisted reproductive technologies. Two authors independently reviewed eligibility, extracted data, and assigned overall quality ratings based on predetermined criteria. Of 1,469 articles identified, nine were eligible. Five enrolled general obstetric populations and four included women undergoing amniocentesis. In five studies in general obstetric populations that included 21,829 pregnancies (1,394 women with leiomyomas and 20,435 without), only one adjusted for potential confounders. This meta-analysis revealed no increase in risk of spontaneous abortion among those with leiomyomas compared with those without (11.5% compared with 8.0%; risk ratio 1.16, 95% CI 0.80-1.52). When bias from confounding was estimated for nonadjusted studies, the aggregate calculated risk ratio was 0.83 (95% CI 0.68-0.98). Leiomyoma presence was not associated with increased risk of spontaneous abortion in an analysis of more than 20,000 pregnant women. Failure of prior studies to adjust for confounders may have led to the common clinical belief that leiomyomas are a risk factor for spontaneous abortion.

Effect of Maternal Retroplacental Leiomyomas on Fetal Growth

(Abstracted from J Obstet Gynaecol Can 2016;38(12):1100–1104) Leiomyomas or fibroids are benign tumors that grow from smooth muscle cells and occur most commonly within the uterine wall. The presence of uterine leiomyomas in pregnancy has been associated with fetal growth restriction, malpresentation, cesarean delivery, premature birth, placenta previa, and fetal death, although not all studies support an increased risk of adverse outcomes.

Obstetric outcomes of intramural leiomyomas in pregnancy

Aim: The authors aimed to study larger intramural leiomyoma with a size of ≥ three cm on pregnancy outcome of singleton pregnancies compared with control group. Materials and Methods: The hospital records of all pregnancies followed between years of 2009 and 2013 were searched for the diagnosis of intramural leiomyoma in the second trimester ultrasonographic screening, past medical history, demographics, pregnancy follow up, and pregnancy outcomes of pregnant women. In the data analyses, 112 singleton pregnant women with intramural leiomyoma were included in the study group and 168 singleton pregnant women without leiomyoma were included in the control group. Results: The presence of pregnancy associated leiomyoma was found to be a risk factor for abortion (odds ratio (OR):12.6, 95% confidence interval (CI) 2.5?63.6) hospitalization for pain (OR: 19.6, 95% CI 5.8?66.5), premature rupture of membranes (OR: 6.7, 95% CI 1.4-32.4), oligohydramniosis (OR: 5.3, 95% CI 1.4?20.0), preterm birth (OR: 4.7, 95% CI 1.9?11.6), and breech presentation and other abnormal presentations (OR: 9.7, 95% CI 2.8?34.2) and neonatal intensive care need (OR: 3.0, 95% CI 1.2-7.5). No correlation with the rate of intrauterine growth restriction, intrauterine fetal death, placenta previa, abruption of placenta, and cesarean section was found. Conclusions: Pregnancy associated intramural leiomyoma is a risk factor for some perinatal complications and these results may be useful for prenatal counseling.

Myomectomy during Caesarean Section is Likely Feasible

Uterine leiomyoma is the most common uterine neoplasm of women. The latest statistics confirm that uterine leiomyomas are present in 20-50% women of reproductive age [1]. Indeed, they are found in up to 77% of women if the uterus is examined closely at autopsy [2]. The incidence of uterine leiomyomas in pregnancy varies from 1.6% to 10.7% according to the trimester of assessment and the size threshold [3-6], with fibroids being more frequent in women of advancing maternal age, as with other high risk obstetrical factors, there has been an increasing incidence of pregnancies complicated by uterine leiomyomas in recent years. The majority of leiomyomas are asymptomatic and might not need any therapy. However, uterine leiomyomas demonstrate their maximum growth during the reproductive period and have a definite impact on pregnancy and childbirth. Compared with normal unaffected gestations, pregnancies associated with uterine leiomyomas also result in a six fold increase in the rate of caesarean section [7]. However, the diagnosis of uterine leiomyomas during pregnancy is neither simple nor straightforward. Only 42% of large fibroids (>5 cm) and 12.5% of smaller fibroids (3-5 cm) can be found in physical examination [8]. The fibroids diagnosed by ultrasound in pregnancy are even more limited, because it is difficult to differentiate fibroids from physiologic thickening of the myometrium [9-11]. Qidwai et al researched 15,104 women underwent routine second trimester prenatal ultrasonography and 401 (2.7%) women were identified with at least 1 leiomyoma from 1993 to 2003 [12].

Single nucleotide polymorphisms in both endometriosis and ovarian cancer

Sir Pain is the most common complication of leiomyoma in pregnancy (1). Severe abdominal pain can occur if a leiomyoma undergoes degeneration, which occurs in 5–8 of leiomyomas during pregnancy (2,3). We wish to call attention to successful severe pain management by epidural administration of a local anesthetic via a subcutaneous injection port in a 32-year-old primigravida who had degeneration of uterine leiomyomas at 23 weeks pregnancy. She had been referred to our hospital because of uncontrolled abdominal pain. On axial T2-weighted MRI imaging, two 14 9 9 cm and 11 9 8 cm intramural myomas with degeneration were detected in the right lateral and postero-inferior body of the uterus. The degree of her abdominal pain was 910 on a visual analog scale (VAS) and she had regular uterine contractions. She was treated with intravenous ritodrine hydrochloride for the preterm contractions. Acetoaminophen, codeine and even intravenous pethidinemeperidine failed to control her pain. At our pain clinic we administered local anesthesia by epidural and patient controlled analgesia (PCA) was initiated with a dose of fentanyl 6 gh and 0.25 ropivacaine 6 mLh. The pain improved dramatically to a VAS degree 210. Considering the risk of infection associated with a percutaneuous epidural catheter, we used the epidural catheterization with a subcutaneous injection port. The epidural catheter was tunneled into the subcutaneous tissue under local anesthesia and connected to the port, which was implanted in the left lower abdomen. The PCA was connected to the port, and we administered 0.25 ropivacaine, 6 mLh without fentanyl. Antibiotic cover was given. The patient achieved adequate pain relief using this implanted port for 22 days and was scheduled for discharge. Unfortunately, preterm premature rupture of membrane occurred at 27 weeks gestation. Three days later the amniotic fluid index was <2 cm and variable fetal heart rate decelerations were noted, prompting an emergency cesarean section. The baby, weighing 940 g with Apgar score of 2 and 4 at 1 and 5 min, respectively, died in the neonatal unit 1 week later. Epidural analgesia has been applied for severely painful leiomyoma during pregnancy before (4), but epidural catheterization with a subcutaneous injection port in pregnant women has not been reported. Our patient improved and successfully retained the epidural catheterization with a subcutaneous injection port for 27 days.

Resection of Degenerated Leiomyoma by Laparotomy during Second Trimester of Pregnancy with Favorable Outcome: A Case Report and Review of Literature Regarding Leiomyomas during Pregnancy

Aims: We present a case of degenerated leiomyoma in pregnancy causing pain that deteriorated with conservative management and was successfully treated with myomectomy. Presentation ofCase: A 37-year-old woman with a known asymptomatic subserosal leiomyoma was admitted to the obstetrics clinic of our hospital at the gestational age of 18+3 weeks due to gradually worsening constant right quadrant lower abdomi nal pain of acute onset. Clinical examination, laboratory investigation and abdominal ultrasonography led to the conclusion that the pain was due to the degeneration of the leiomyoma. The initial conservative approach was not effective so the subserous lei omyoma was resected by laparotomy. The pregnancy progressed normally until the delivery of a healthy neonate at 37+5 weeks gestational age by cesarean section due to the prior myomectomy. The

Management of uterine leiomyomas in pregnancy: review of literature

The incidence of uterine myomas in pregnancy is estimated from 0.1 to 3.9 %. Although a lot of women with uterine fibroids bring the pregnancy without adverse events, data provided in the literature suggest that uterine fibromyomas are associated with several complications. The most important clinic question concerns the impact of myoma on pregnancy and, in some cases, the possibility of a surgical treatment that guarantees a good security for the pregnancy course and the conservation of reproductive capacity. Electronic search of Pubmed between 1993 and 2011, using specific keywords. Management of leiomyomas in pregnancy is conservative and limited, when it is necessary, to medical therapy. The main conditions that induce inevitably the surgical procedure are the torsion of pedunculated fibroid or rare cases of necrosis and resultant inflammatory peritoneal reaction. Laparoscopy technique has several advantages in comparison to previous techniques such as best postoperative course with reduction of pain, fast recovery, less hospitalization and, absence of large and unaesthetic scars. The importance of maternal and fetal welfare thus requires a careful evaluation of several factors that, varying from case to case, lead the authors to choose the most appropriate management.

Cervical leiomyomas in pregnancy: Report of 17 cases

To analyse the management strategies and delivery outcomes of women with cervical leiomyomas in pregnancy. We retrospectively analysed the pregnancy outcomes of 17 women with cervical leiomyomas. The outcome measures assessed included the volume of blood loss at delivery, need for blood transfusion, intra- and post-operative complications and length of hospital stay. The mean diameter of the leiomyomas was 10.4±7.2cm, with a range of 3-30cm. The mean blood loss was 697±394mL (range of 350-4200mL). Six women (35.3%) required a blood transfusion. The mean duration of stay in hospital after delivery was 7.9±3.9days (range 4-20days). There were three cases of severe haemorrhage or infection post-operation necessitating hysterectomy, and all of the leiomyomas in these cases were more than 20cm in diameter. There was a positive correlation between the blood loss volume and the size of leiomyomas (correlation coefficient 0.638, P<0.01). The dimensions of cervical leiomyomas influences post-partum blood loss. Large cervical leiomyomas appear associated with adverse outcomes. When the leiomyomas are relatively small, an experienced practitioner could consider myomectomy during a caesarean delivery.

Vaginal Leiomyoma in Pregnancy: A Case Report

Vaginal leiomyoma is a rare, benign tumor with variable clinical presentations. Vaginal leiomyoma usually arises in the midline anterior wall. Like uterine leiomyomas, vaginal leiomyomas occur most frequently between the ages of 35 and 50 years. Depending on the size and location, vaginal leiomyomas may produce diverse clinical symptoms, such as dyspareunia, pain, or dysuria. We report a case of a vaginal leiomyoma, diagnosed in a 39 weeks pregnant 25-years-old woman suffering from dyspareunia and surgically excised three mounts after cesarean section.

Severe Hypercalcemia Associated With Uterine Leiomyoma in Pregnancy

Uterine leiomyomas are the most common pelvic tumor, and a frequent indication of the need for gynecologic surgery. Although usually asymptomatic, life-threatening cases can occur. We present a case of critical hypercalcemia associated with a leiomyoma during pregnancy with the intention of highlighting the endocrinology of leiomyomas, features shared with malignant neoplasms, and the potential for effects on obstetric outcomes. A 32-year-old gravid woman with a large leiomyoma presented at 33 5/7 weeks of gestation with critical hypercalcemia requiring intensive care. Postpartum myomectomy cured her hypercalcemia, which was driven by parathyroid hormone-related protein (PTHrP) produced by the tumor. Obstetricians should be aware of the existence of humoral hypercalcemia related to leiomyomas and the potential effects on pregnancy.

Cervical and Prolapsed Submucosal Leiomyomas Complicating Pregnancy

Cervical and prolapsed submucosal leiomyomas are rarely seen in pregnancy. Depending on the size threshold used to diagnose a leiomyoma, the prevalence of uterine leiomyomas in pregnancy is approximately 3% to 10%. The prevalence of clinically evident cervical leiomyomas in pregnancy is less than 1%. Contrary to prior thought, the majority of uterine leiomyomas in pregnancy do not usually lead to complications. Indications for surgical intervention in pregnancy for cervical leiomyomas include bleeding, infection, degeneration, pain, and urinary stasis. Preoperative imaging with ultrasound and magnetic resonance imaging may help to delineate the location and nature (e.g., pedunculated) of the cervical leiomyoma when clinical examination is inconclusive. We reviewed the current literature in regard to cervical leiomyomas in pregnancy and summarize the major findings. After completing this CME activity, readers should be better able to evaluate the prevalence and natural history of uterine and cervical leiomyomas in pregnancy, assess indications for surgical intervention in pregnant patients, manage surgical complications, and select imaging modalities that may determine their origin. Obstetricians & Gynecologists, Family Physicians Learning Objectives: After completion of this educational activity, the reader should be better able to evaluate the prevalence and natural history of uterine leiomyomas in pregnancy; assess indications for surgical intervention in pregnant patients; manage surgical complications; and select imaging modalities that may determine their origin.

Birth outcomes and pregnancy complications of women with uterine leiomyoma—a population-based case-control study

Objective Uterine leiomyoma is not a rare pathological condition in pregnant women; thus the aim of the study was to evaluate the recent progress in the treatment of these pregnant women on the basis of the association of leiomyoma in pregnancy (LP) with pregnancy complications and birth outcomes including structural birth defects, i.e. congenital abnormalities (CA) in the offspring. Design Cases with CA and matched controls without CA in the population-based Hungarian Case-Control Surveillan- ce System of Congenital Abnormalities (HCC SCA) were evaluated. Only women with prospectively and medically recorded LP in prenatal maternity logbook and medically recorded birth outcomes (gestational age, birth weight, CA) were included to the study. Setting the HCCSCA, 1980-1996 contained 22,843 cases with CA and 38,151 matched controls without CA. Population Hungarian pregnant women and their informative offspring: live births, stillbirths and prenatally diagnosed malformed fetuses. Methods Comparison of birth outcomes of ca- ses with matched controls and pregnancy com- plications of pregnant women with or without LP. Main outcome measures Pregnancy complications, mean gestational age at delivery and birth weight, rate of preterm birth, low birthweight, CA. Results A total of 34 (0.15%) cases had mothers with LP compared to 71 (0.19%) controls. There was a higher incidence of threatened abortion, placental disorders, mainly abruption placentae and anaemia in mothers with LP. There was no significantly higher rate of preterm birth in the newborns of women with LP but their mean birth weight was higher and it associated with a higher rate of large birthweight newborns. A higher risk of total CA was not found in cases born to mothers with LP (adjusted OR with 95% CI = 0.7, 0.5-1.1), the spe- cified groups of CAs were also assessed versus controls, but a higher occurrence of women with LP was not revealed in any CA group. Con- clusions Women with LP have a higher risk of threatened abortion, placental disorders and anaemia, but a higher rate of adverse birth outcomes including CAs was not found in their offspring.

Three-dimensional power Doppler in the evaluation of painful leiomyomas and focal uterine thickening in pregnancy

Objective: To determine the usefulness of 3-dimensional (3D) power Doppler ultrasound in distinguishing painful leiomyomas from focal myometrial contractions or nonpainful leiomyomas in pregnancy. Methods: A 2D section of the area of interest in the uterine wall was first obtained in 29 patients to determine whether the pain originated from a myoma or a uterine contraction. Then, volume acquisition was activated and Doppler indices (vascularization index, flow index, and vascularization–flow index) were calculated for thickened and normal uterine wall. Results: Of 15 patients found to have uterine myomas, 11 had multiple tumors and 4 had single tumors. In the remaining 14 patients the painful uterine thickening proved to be a focal contraction. Painful segments of uterine thickening were associated with lower Doppler indices. Painful myomas were found to have significantly lower indices than normal uterine wall (P=0.008, 0.03, and 0.01 for VI, FI, and VFI, respectively, vs. 0.001, 0.003, and 0.01). However, the differences in indices between nonpainful myomas and uterine wall on the one hand, and nonpainful myomas and focal uterine contractions on the other, were not statistically significant. Conclusion: Three-dimensional power Doppler ultrasound may be a sensitive and reliable tool for distinguishing painful uterine myomas from focal myometrial contractions and nonpainful myomas.

Cotyledonoid Leiomyoma in Pregnancy

Benign smooth-muscle tumors (leiomyomata) are the most frequent tumors found in the female genital tract. They are easy to diagnose in pregnancy and usually managed conservatively. Some variant forms with unusual infiltrative growth pattern have been known, but they are rare in pregnancy. The variant forms pose diagnostic and management difficulties. An unusual type of leiomyoma (cotyledonoid), adhering to the bowels and occupying the whole left broad ligament, was excised completely at 14 weeks of gestation, and the pregnancy continued to term. Familiarity with benign uterine smooth-muscle tumors with unusual growth patterns by gynecologists and pathologists is essential in avoiding over-treatment.

Management of a massive leiomyoma in pregnancy

This is a case report of a primigravida who was noticed to have a large pelvic mass at the time of her “booking” scan. A magnetic resonance imaging (MRI) scan was performed in order to elucidate the exact nature of the mass, which enlarged between successive scans. The appearances were in keeping with a leiomyoma undergoing degenerative change. The patient underwent a laparotomy in pregnancy to remove the leiomyoma, which was found to contain fluid-filled cavities. The uterine cavity was not breached at the time of surgery. The pregnancy continued uneventfully until term, and the baby was delivered by caesarean section. The postnatal period was uneventful.