Uterine Myomas in Pregnancy Increase Risk of Complications


LAS VEGAS — Uterine myomas that are present during pregnancy are significantly associated with pregnancy complications, including first- and second-trimester miscarriage, malpresentation of the baby at delivery, and preterm labor, Dr. Radwan Assad reported at the annual meeting of the American Association of Gynecologic Laparoscopists.

In addition, “a cesarean delivery in the presence of a low anterior myoma is associated with a high incidence of postpartum hemorrhage,” said Dr. Assad of Wayne State University, Detroit.

Findings from previous studies have linked uterine myomas to pregnancy complications including preterm labor, placental abruption, and postpartum hemorrhage.

To further study the effect of uterine myomas on pregnancy complications, Dr. Assad and colleagues reviewed data from 155 women who were diagnosed with myomas during pregnancy. Overall, 45% of the women had vaginal deliveries and 55% cesarean deliveries.

Malpresentation at delivery (the most common complication) occurred in 22% of the patients. Of these cases, 16.8% were breech, 3.9% were transverse, and 1.3% were oblique. Other complications included growth restriction (17.4%), preterm labor (17.4%), and premature rupture of membranes (16.1%). In addition, 7.7% of the women had first-trimester miscarriages and 5.8% had second-trimester miscarriages.

Overall, the risk of postpartum hemorrhage was 27.3% among women who had cesarean deliveries, compared with only 2.6% among women who had vaginal deliveries. Notably, a low-lying anterior fibroid was associated with an eightfold risk of postpartum hemorrhage among women who had cesarean deliveries, Dr. Assad noted.

“But there was no correlation between the number of fibroids and the risk of postpartum hemorrhage,” he said.

Early postpartum hemorrhage was defined as an estimated blood loss of more than 500 cc during a vaginal delivery and more than 1,000 cc during a cesarean delivery.

Myomectomies (which have been shown to reduce the risk of miscarriage in women with fibroids) were performed in 9% of the women who had cesarean deliveries, and the myomectomies were not associated with an increased risk of postpartum hemorrhage in these patients, Dr. Assad said.

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