Uterine Fibroids In Pregnancy Research Articles

Ultrasound-guided laparoscopy for conservative management of a massive degenerated uterine fibroid during pregnancy: A case report

ObjectiveTo outline the key steps in the management of a massive, degenerated fibroid during pregnancy. DesignA video article demonstrating diagnostic imaging, laparoscopic anatomy, and innovative surgical technique. SettingThis video demonstrates an unusual presentation of a uterine fibroid in pregnancy. Uterine fibroids are common, with an incidence of 40%–60% by the age of 35 with a possibility of growing in pregnancy and impacting the developing fetus. InterventionsThis case summarizes an innovative, safe, and efficient minimally invasive surgery approach to a patient with a 30-cm degenerated fibroid at 16 weeks gestational age of pregnancy, permitting ongoing development of the viable fetus. Review of imaging revealed a solid-cystic uterine mass, suspicious for degenerated fibroid, compressing the gestation into the right upper quadrant. The patient did not have a reported history of a uterine mass prior to pregnancy. Interdisciplinary care with maternal-fetal medicine and gynecologic oncology ensured thorough counselling and various treatment possibilities. The MIGS team performed ultrasound-guided laparoscopy involving drainage, biopsy, and insertion of a transient drain to prevent re-accumulation of fluid throughout the pregnancy. Pathology revealed fibroid degeneration with infarct-type necrosis. The patient continued successfully in pregnancy until undergoing a Cesarean section at 33 weeks after developing an abscess within the fibroid. Neonatal outcome was excellent. ConclusionOur case demonstrates degeneration with massive expansion of a fibroid, compromising the potential of the fetus. A solution was devised and implemented, allowing for pregnancy continuation until the third trimester.

Surgical and Delivery Outcomes of Coexisting Uterine Fibroids with Pregnancies in Nigeria

Background: Coexisting uterine fibroid with pregnancy is associated with increased pregnancy complications. This study evaluates the prevalence of coexisting uterine fibroids, and surgical and delivery outcomes among pregnant women who had cesarean sections. Methods: This comparative observational study was conducted among pregnant women who had cesarean sections at the labor ward operating room of Ekiti State University Teaching Hospital, Ado-Ekiti, Nigeria. One hundred and five pregnant women aged 20 years - 40 years were recruited and grouped based on the intraoperative presence of grossly visible uterine fibroids (n = 23) and no uterine fibroids (n = 82). Surgical and delivery outcomes were measured. Data were analyzed using IBM SPSS version 26 and the means between the two groups were compared using an independent sample t-test with significance set at p < .05. Results: The prevalence of uterine fibroids found during cesarean sections in this study was 21.9%. The mean age of the participants was comparable (M = 30.25 SD = 5.232). There were statistically significant differences in mean pre-operative packed cell volume (t(df) = 2.077 (65.31) p = .042, estimated blood loss (t(df) = 2.045 (36.664) p =.010, post-op packed cell volume (t(df) = 1.054 (24.035) p = .049, and duration of hospital stay (t(df) = -.235(65.846) p = .019. The study showed that there was a difference in mean surgery time = 7.996 95% CI: -.879 to 16.871 but this was not found to be statistically significant. Conclusion: Uterine fibroid coexisting with pregnancy has a significant effect on the surgery time, estimated blood loss, and length of hospital stay. Therefore, adequate complication readiness and proper follow-up of the patient will be crucial to avert likely complications during and after surgery in women with coexisting uterine fibroid in pregnancy.

Incidence and Antepartum Risk Factors of Severe Postpartum Haemorrhage in Anaemic Pregnant Women in Lagos, Nigeria: A Secondary Cohort Analysis.

The magnitude and risk factors for postpartum haemorrhage (PPH) have been extensively investigated, although little is currently known about the incidence and predictors of severe PPH, specifically among women affected by prenatal anaemia in Nigeria. The study determined the incidence and antepartum risk factors of severe PPH in anaemic pregnant women in five health institutions in Lagos, Southwest Nigeria. A secondary analysis was performed using the data of pregnant women with anaemia from the "Predict-PPH" study that was conducted between January and June 2023. This study included n=570 pregnant women affected by anaemia who gave birth in five hospitals in the Lagos metropolis of Nigeria. The study outcome was severe PPH, defined as an estimated blood loss of at least 1000 mL within 24 hours of childbirth. A backward stepwise conditional approach in a multivariable logistic regression model was utilised to identify the independent risk factors for severe PPH in anaemic pregnant women. Of the 570 women with prenatal anaemia enrolled in the primary study, 42 (7.4%) had severe PPH. The identified independent risk factors for severe PPH were maternal obesity (adjusted OR = 3.85, 95% CI = 1.85-8.02), antepartum haemorrhage in index pregnancy (adjusted OR = 2.98, 95% CI = 1.29-6.90), uterine fibroids (adjusted OR = 6.10, 95% CI = 2.39-15.52), delivery gestational age ≥39 weeks (adjusted OR = 2.62, 95% CI = 1.23-5.56), and delivery by caesarean birth (adjusted OR = 16.75, 95% CI = 5.81-48.31). About one in 13 anaemic pregnant women enrolled in the study developed severe PPH during childbirth. Maternal obesity, antepartum bleeding in the current pregnancy, co-existing uterine fibroids in pregnancy, delivery gestational age beyond 38 weeks, and caesarean birth in the current pregnancy were factors that were significantly associated with severe PPH in anaemic pregnant women. These findings underscore the importance of increased vigilance during both the antenatal and peripartum periods to identify women with these risk factors for the initiation of timely interventions to prevent severe PPH.

482 Associations between antepartum anemia and uterine fibroids in pregnancy by race and ethnicity

482 Associations between antepartum anemia and uterine fibroids in pregnancy by race and ethnicity

Selecting the best surgical approach in various cases of prolapsed pedunculated submucosal fibroids: A case series

IntroductionThe pedunculated fibroid is classically managed through vaginal myomectomy. However, vaginal myomectomy cannot be safely and easily performed in all cases. We reviewed three cases of prolapsed pedunculated submucosal fibroids, each with a specific surgical difficulty. Presentation of casesThe first case had a prolapsed pedunculated uterine fibroid in pregnancy and underwent fibroid extirpation during an emergency cesarean section through the lower uterine segment incision. The second case was a nulliparous woman with recurrent abnormal uterine bleeding due to a giant prolapsed pedunculated uterine fibroid who underwent laparotomy fibroid extirpation through posterior colpotomy, preserving the uterus. The third case had a prolapsed pedunculated uterine fibroid in perimenopause with multiple fibroids and underwent fibroid stalk excision through an isthmic incision to facilitate a safe laparotomy hysterectomy procedure. DiscussionVaginal removal has become the standard surgical method for prolapsed pedunculated submucous fibroids. However, some possible consequences of vaginal myomectomy include severe stalk bleeding, infection, and uterus inversion induced by excessive traction. Therefore, specific approaches are needed in some circumstances. ConclusionCustomised surgical approaches provided safe and efficient access to the prolapsed pedunculated fibroid stalk during myomectomy or hysterectomy.

A Rare Case of Large Uterine Fibroid in Pregnancy

A Rare Case of Large Uterine Fibroid in Pregnancy

Comparative Study Between Vaginal Natural Progesterone and Oral Dydrogesterone in Prevention of Red Degeneration of Uterine Fibroid in Pregnancy

Comparative Study Between Vaginal Natural Progesterone and Oral Dydrogesterone in Prevention of Red Degeneration of Uterine Fibroid in Pregnancy

Coexisting fibroid in pregnancy and its labour outcome in Nigeria

The management of coexisting uterine fibroid in pregnancy is controversial. There is the need to know the labour outcome of women with coexisting fibroid in pregnancy in our environment. Objective: To ascertain the labour outcome of coexisting fibroid in pregnancy and the prevalence. Materials and Method: The study is a retrospective one that reviewed 48 women with coexisting fibroid in pregnancy over a 30 month period. Result: Out of 612 women that had antenatal care and delivery in our area of study, 48 of them had coexisting fibroid in pregnancy giving a prevalence of 7.8%. The mean age of the parturients was 32.38 ± 5.22 years and most of the parturients were primiparous (56.3%). Up to 89.5% of them delivered at term and 89.6% of their babies had normal birth weight with good APGAR score in 79.2% of them. Their caesarean delivery rate was 79.2% and 2 successful caesarean myomectomies were done. Conclusion: Fibroid can coexist with pregnancy with good outcome but they are prone to high caesarean delivery rate and at risk of uterine rupture. A low prevalence was recorded in our study and caesarean myomectomy is feasible in selected cases.

Uterine Fibroids in Pregnancy

OBJECTIVES: To determine the maternal and fetal outcomes associated with uterine fibroids in pregnancy. METHODOLOGY: This study was conducted in the Gynaecology Department of Mardan Medical Complex from January 2018 to December 2019. All pregnant women of any age or parity or gestational age with sonographic evidence of uterine fibroids were included. Demographic details, gestational age, symptoms related to fibrosis, size, number and location of the fibroid, mode of delivery, antenatal, intrapartum and postnatal complication, and neonatal outcome were entered in a predesigned proforma. RESULTS: The incidence of uterine fibroids in pregnancy was 0.8%.77 patients were enrolled. The mean age was 26.5 + 3.22 years. The mode of delivery was a caesarean section in 32.4%, and vaginal delivery in 53% of patients.14% of patients miscarried. Fibroids were multiple in 58.4% and single in 41.5% of patients. Submucosal fibroids were seen in 23%, intramural in 18% and subserosal in 58% of cases. The most common maternal complication was abdominal pain (25%), followed by postpartum haemorrhage(23%) and antepartum haemorrhage(19%). Neonatal outcome was good, with 57% of babies being healthy and 9% being admitted to the Neonatal Intensive Care Unit (NICU) and discharged later. CONCLUSION: Pregnant women with fibroids should be cautiously screened during antenatal to avoid obstetric complications.

Uterine fibroids in pregnancy.

Most fibroids are small (< 5 cm) and remain stable in size. Although 30% of fibroids will increase in response to hormonal changes of pregnancy, most typically regress postpartum.[1][1] Fibroids are usually asymptomatic; complications increase with more and larger fibroids. Pain occurs when a

Huge symptomatic pedunculated uterine fibroid in pregnancy: Antepartum myomectomy and term delivery at a specialist hospital in Kano, Nigeria

Myomas are common in pregnancy and can go unnoticed. One in ten patients, however, develops complications that would necessitate their removal. Myomectomy performed at caesarian section had come to the lime light over the last decade and recent literature have shown its safety. There is still paucity of literature on myomectomy performed during pregnancy. Our case was a 25 years old primigravida at 21 weeks with features of acute abdomen secondary to uterine fibroid which was diagnosed during pregnancy. She subsequently had antepartum myomectomy and a live birth at term via caesarean section.

Pregnancy outcomes in women with large uterine fibroids

Study aim To evaluate the effects of the combination of Arabin pessary or cervical cerclage with vaginal micronised progesterone versus micronised progesterone or no medical management on the outcomes of pregnancies in women with large uterine fibroids Materials and methods This was a retrospective, observational, controlled study in 120 women aged 18–45 years with large uterine (≥8 cm) fibroids diagnosed in the first trimester, who underwent treatment in the regional perinatal center of the Omsk Regional Clinical Hospital between 2015 and 2019. Women in Group A (n = 90) were divided into two subgroups. In Subgroup А1 (n = 35), participants received the combination of a cervical procedure (Arabin pessary or cerclage) and micronised progesterone, and in Subgroup А2 (n = 55) all participants additionally underwent myomectomy. In Group B (n = 18), only micronised progesterone was used. In Group C (n = 12), no medical therapy was administered during pregnancy. Results Large uterine fibroids in pregnancy were associated with a threatened pregnancy loss in 46.4% of women and pain in almost 40% of women. Myomectomy in pregnancy was performed in 55 women. The combination of Arabin pessary or cervical cerclage with micronized progesterone reduced the rates of preterm delivery by 2.2-fold versus the progesterone-only group and by 11.2-fold versus no medical management group (χ 2 = 19.4; p = .0001). Conclusion The combination of Arabin pessary or cervical cerclage with micronized progesterone in our study helped achieve term deliveries in >90% of pregnant women with large fibroids.

Comparative Study Between Vaginal Natural Progesterone and Oral Dydrogesteron in Preventinon of Red Degeneration of Uterine Fibroid in Pregnancy.

Background: Uterine leiomyomas are highly prevalent benign monoclonal tumors, arising from the smooth muscle of the myometrium; The most serious complication of uterine fibroids; is red degeneration that causes severe pain, and may lead to preterm labour, miscarriage, fetal and maternal morbidity and mortality.Aim: This work was designed to compare between the effect of vaginal natural MP and oral dydrogesterone in preventionof red degeneration of uterine fibroid during pregnancy.Material and Methods: Patients were recruited from El-Shatby Maternity University Hospital. They were 50 pregnant females, diagnosed having a uterine fibroid more than 3 cm in size then there were divided into two groups, group (A): twenty five treated by vaginal natural Progesterone, group (B): twenty five treated by oral Dydrogesterone.All patients at 14-15 weeks of gestational age underwent complete history taking, clinical examination and ultrasound examination for mean gestational age and assessment of the type and uterine fibroid.Results: Results showed that there were no statistical significant differences as regards age, obstetric history (gravidity and parity), number, Site, grade and size of the fibroid. There was a significant difference between the two studied groups, regarding the acute abdominal pain, it occurred to only 3 cases (12%) in group (A), versus to 16 cases (64%) in group (B). Regarding occurrence of red degeneration, it occurred only to 3 cases (12%) in group (A), while in group (B) it occurred to 15 cases (60%).Conclusion : Vaginal natural micronized progesterone is more effective than oral dydrogesterone in prevention of red degeneration of uterine fibroids with fewer complications like acute abdominal pain and preterm labour

Seeing red degeneration in uterine fibroids in pregnancy: proceed with caution

Seeing red degeneration in uterine fibroids in pregnancy: proceed with caution

Sonographic findings in first trimester vaginal bleeding at Moi teaching and referral hospital

Background: First trimester per vaginal bleeding may be an indication of early pregnancy failure. Clinical management relies on sonography with delay or inadequate diagnosis leading to pregnancy loss or maternal mortality. Objective: To describe the ultrasound findings in patients referred with first trimester bleeding in relation to their clinical characteristics. Methods: This was a cross-sectional study. A total of 201 women who had first trimester vaginal bleeding were recruited. Study was done at Moi Teaching and Referral hospital (MTRH), between November 2015 and October 2016. Associations were assessed using Fisher’s exact test and results were presented in tables and graphs. Results: Median age was 27.0 years. The most common Ultrasound findings were incomplete abortion (22.9%), Uterine Fibroids in Pregnancy was diagnosed in (15.4%) and Extra uterine Pregnancy (14.4%). Significant clinical association were; Complete and incomplete abortion was associated with prolonged and heavy bleeding (p = 0.003 and &lt;0.001 respectively). Majority diagnosed with incomplete abortion had no history of contraceptive use (p = 0.003). Anembryonic pregnancy was associated with spotting (p = 0.008). Diagnosis of extra uterine pregnancy was associated with spotting. Conclusion: Incomplete abortion, uterine fibroids in pregnancy and ectopic pregnancy were common sonographic findings. Ectopic pregnancy was associated with previous history of contraceptive use.

Symptomatic uterine fibroids in pregnancy — wait or operate? Own experience

Uterine fibroids are one of the most common benign tumors of the female genital tract. The major complication of myomas in pregnancy is a recurrent pain, however the misscariage is the main threat. The negative impact of myomas on the course of pregnancy may also result in i.e. uterine bleeding, higher incidence of a maternal-fetal incommunicability, an incorrect position of the fetus and its deformities. The patient aged 31 was admitted to Mother and Child Health Center in Zabrze due to the threatened miscarriage. The primigravid at 19 weeks' gestation was previously diagnosed with myoma. On admission the ultrasonography revealed one alive fetus in the uterus and a nodular change on the right side of the uterine fundus, 13 x 11 cm in size and non-homogenous echo. The patient was qualified to the conservative myomectomy. 11 days after the enucleation of 25 cm in diameter myoma, patient in good condition, with the maintained, alive foetus was discharged from the hospital. Patient at 34 weeks' gestation was re-admitted due to the beginning of uterine contraction. After one week of observation within the ward, with tocolytic drugs and steroids administered, at 35th week of pregnancy the patient gave birth to a live daughter via the Ceasarian section. Prenatal myomectomy can be safely performed in the first and second trimester of pregnancy, however it is recommended to deliver the baby via Caesarean section, due to fear of intrauterine rupture of the uterus.

Diagnostic ambiguity of aseptic necrobiosis of a uterine fibroid in a term pregnancy: a case report

BackgroundUterine fibroids are the most common uterine tumours in females of reproductive age. During pregnancy, uterine fibroids may be complicated by aseptic necrobiosis. We herein report an ambiguous clinical presentation of uterine fibroids in pregnancy and discuss the diagnostic challenges encountered in our resource-constraint setting.Case presentationA term pregnant Cameroonian woman was admitted to our maternity unit with clinical findings suggestive of a strangulated umbilical hernia. She underwent an emergency caesarean section which fortuitously revealed aseptic necrobiosis of a uterine fibroid, managed within the same surgical intervention by myomectomy. Her post-operative course was uneventful.ConclusionThe authors highlight the need for a high index of suspicion by healthcare providers, as well as the need for a multidisciplinary approach for a favourable maternal and foetal outcome.

Obstetrical Outcomes of Ultrasound Identified Uterine Fibroids in Pregnancy.

Objective We aimed to determine if fibroids in pregnancy, categorized by size, are associated with adverse obstetrical outcomes. Study Design Demographic, clinical, and delivery data were collected from charts of women with singleton gestations who delivered at >20 weeks gestation with fibroids identified at routine anatomy scan and their randomly selected age-matched controls. Largest fibroid diameter was used to categorize small fibroids (≤5 cm) and large fibroids (>5 cm). Results We included 450 patients: 264 patients with fibroids (174 small, 90 large fibroids) and 186 age-matched controls. Women with large fibroids had significantly greater blood loss than women with small fibroids and women with no fibroids (p-value <0.0001 and <0.0001 after adjusting for delivery mode). When fibroid size was compared individually, there was a significantly higher rate of primary cesarean section in both small and large fibroid groups when compared with women with no fibroids (p-values 0.044 and 0.003 after adjusting for body mass index). Conclusion Women with fibroids in pregnancy have higher rates of primary cesarean delivery and are at significant risk for increased blood loss at the time of delivery.

561: Outcomes of ultrasound identified uterine fibroids in pregnancy

561: Outcomes of ultrasound identified uterine fibroids in pregnancy

Management of uterine fibroids in pregnancy: recent trends.

The review analyzes how fibroids may influence pregnancy and how myomas may be modified by pregnancy. The most important clinical aspect concerns the impact of myoma on pregnancy and the possibility of a well tolerated surgical treatment for the mother and her fetus, preserving maternal reproductive capacity. Fibroids significantly increase in size during early pregnancy and then decrease in the third trimester. Although most women with uterine fibroids have a regular pregnancy, data from the literature suggest that they may have a higher risk of fertility problems and pregnancy complications. Myomectomy can increase the rate of pregnancy in women with infertility, attempting to restore a normal anatomy and reduce uterine contractility and local inflammation associated with the presence of fibroids, improving the blood supply. Current evidence does not suggest routine myomectomy during pregnancy or at the cesarean birth, as fibroids-related complications are rare and may be overcome by the risks of surgery. However, in selected cases, myomectomy is a feasible and safe technique and associated to a good outcome.The diagnosis of myomas in pregnancy may require attention for the adequate management to preserve maternal and fetal well-being.