PREGNANCY WITH UTERINE MYOMA AND AFTER MYOMECTOMY: RESULTS OF THE COHORT STUDY

Full Text

Open Access Open Access
Restricted Access Access granted
Restricted Access Subscription or Fee Access

Abstract

Objective - to identify risk factors, complications, and pregnancy outcomes in patients with uterine fibroid (myoma) and after myomectomy. Material and methods. Investigated 100 pregnancy and delivery stories, where 1st group consists of 40 patients with uterine myoma from 3 to 12 cm, 2nd group - 30 patients with a history of myomectomy, 3rd group - control of 30 patients. Results. The average age of patients from group 1 is 34.9 years, group 2 - 35.7 years. Both in group 1 and group 2 there is a large percentage of surgical interventions on the uterus: a history of abortion (35%/20%) and miscarriage (15%/36.6%). Significant sizes of fibroids contribute to incorrect fetal position - breech presentation (17.5%/3.3%), transverse (2.5%), oblique (2.5%). The presence of fibroids is associated with certain complications: the growth of the placenta in the myomatous node (5%), disorder of blood supplying and ischemic changes of the nodes during pregnancy (2.5%), late postpartum hemorrhage (2.5%), fetal distress (12.5%). Surgical delivery by Cesarean section (85%) is the method of choice for uterine myoma, based on a combination of another relative indications. Caesarean section in such patients is associated with an increase in the volume of surgical intervention, in the form of conservative myomectomy according to indications (58.8%), which may be a factor in pathological blood loss (2.5%). Pregnancy and delivery after myomectomy is accompanied by the occurrence of specific complications: scar failure after myomectomy, the threatening of uterine rupture in the scar (6.7%), adhesions in the pelvis III-IV degrees (16.7%).

Full Text

Restricted Access

About the authors

Elena V. Timokhina

I.M. Sechenov First Moscow State Medical University (Sechenov university)

Email: elena.timokhina@mail.ru
Doctor of Medicine, Professor, Associate Professor of the department of Obstetrics and Gynecology of I.M. Sechenov First Moscow State Medical University (Sechenov University), 119435, Moscow, Russian Federation 119991, Moscow, Russian Federation

E. V Gubanova

I.M. Sechenov First Moscow State Medical University (Sechenov university)

119991, Moscow, Russian Federation

T. M Silayeva

I.M. Sechenov First Moscow State Medical University (Sechenov university)

119991, Moscow, Russian Federation

References

  1. Синчихин С.П., Мамиев О.Б., Степанян Л.В. Консервативная монотерапия пациенток с миомой матки. Акушерство и гинекология. 2014; (5): 79-83.
  2. Адамян Л.В., Андреева Е.В., Артымук Н.В., Белоцерковцева Л.Д., Беженарь В.Ф. и др. Миома матки: диагностика, лечение и реабилитация. Клинические рекомендации (протокол лечения). М.; 2015.
  3. Давыдов А.И., Пашков В.М., Шахламова М.Н., Чочаева Е.М., Коваленко М.В. Консервативная миомэктомия: нерешённые вопросы и новый взгляд на предоперационную подготовку пациенток. Вопросы гинекологии, акушерства и перинатологии. 2015; 14 (1): 31-47.
  4. Saleh H.S., Mowafy H.E., Hameid A.A.A.E., Sherif H.E., Mahfouz E.M. Does uterine fibroid adversely affect obstetric outcome of pregnancy? Biomed. Res. Int. 2018; 2018: 8367068. doi: 10.1155/2018/8367068
  5. Lee H.J., Norwitz E.R., Shaw J. Contemporary management of fibroids in pregnancy. Rev. Obstet. Gynecol. 2010; 3(1): 20-7.
  6. Tomczyk K.M., Wilczak M., Rzymski P. Uterine rupture at 28 weeks of gestation after laparoscopic myomectomy - a case report. Menopause Rev. 2018; 17(2):101-4.
  7. Кира Е.Ф., Политова А.К., Гудебская В.А., Кузьмичев В.С. Роль лапароскопической робот-ассистированной миомэктомии при восстановлении фертильности у больных с миомой матки в репродуктивном периоде. Акушерство и гинекология. 2016; (3): 58-63.
  8. Беженарь В.Ф., Долинский А.К., Ярмолинская М.И., Цыпурдеева А.А., Чмаро М.Г. Эффективность преодоления бесплодия при выполнении миомэктомии. Архив акушерства и гинекологии им. В.Ф. Снегирёва. 2014; 1 (1): 28-35.
  9. Kameda S., Toyoshima M., Tanaka K., Fujii O Iida S., Yaegashi N., et al. Utility of laparoscopic uterine myomectomy as a treatment for infertility with no obvious cause except for uterine fibroids. Gynecol. Minim. Invasive Ther. 2018; 7(4):152-5.
  10. Стрижаков А.Н., Буданов П.В., Давыдов А.И., Рыбин М.В. Спонтанный разрыв матки в родах после лапароскопической миомэктомии. Вопросы гинекологии, акушерства и перинатологии. 2012; 11 (5): 79-82.
  11. Серов В.Н., Адамян Л.В., Филиппов О.С., Артымук Н.В., Белокриницкая Т.Е., Баев О.Р. и др. Кесарево сечение. Показания, методы обезболивания, хирургическая техника, антибиотикопрофилактика, ведение послеоперационного периода. Клинические рекомендации (протокол лечения). М.; 2014.
  12. Sarwar I., Habib S., Bibi A., Malik N., Parveen Z. Clinical audit of foeto maternal outcome in pregnancies with fibroid uterus. J. Ayub. Medical College, Abbottabad: JAMC. 2012; 24(1): 79-82.
  13. Noor S., Fawwad A., Sultana R., Bashir R., Quratul A., Jalil H. et al. Pregnancy with fibroids and its obstetric complication. J. Ayub. Medical College, Abbottabad: JAMC. 2009; 21(4): 37-40.
  14. Можейко Л.Ф., Гузей И.А., Белонович К.В. Миома матки: этиопатогенез, течение беременности и родов. Охрана материнства и детства. 2014; 1(23): 99-103.
  15. Zhao R., Wang X., Zou L., et al. Adverse obstetric outcomes in pregnant women with uterine fibroids in China: A multicenter survey involving 112,403 deliveries. PLoS One. 2017; 12(11): e0187821.
  16. Лапотко М.Л. Органосохраняющее лечение миомы матки: Дис. … канд. мед. наук. Минск; 2010.
  17. Kim M.S., Uhm Y.K., Kim J.Y., Jee B.C., KimY.B. Obstetric outcomes after uterine myomectomy: Laparoscopic versus laparotomic approach. Obstet. Gynecol. Sci. 2013; 56(6): 375-81.
  18. Radhika B.H., Naik K., Shreelatha S., Vana H. Case series: pregnancy outcome in patients with uterine fibroids. J. Clin. Diagn. Res. 2015; 9(10): QR01-4.
  19. Zeghal D., Ayachi A., Mahjoub S., Boulahya G., Zakraoui A., Ben Hmid R., et al. Fibroids and pregnancy: complications. Tunis Med. 2012; 90(4): 286-90.
  20. Conti N., Tosti C., Pinzauti S., Tomaiuolo T., Cevenini G., Severi F.M. et al. Uterine fibroids affect pregnancy outcome in women over 30 years old: role of other risk factors. J. Matern. Fetal Neonatal Med. 2013; 26(6): 584-7.
  21. Navid S., Arshad S., Qurat-ul-Ain, Meo R.A. Impact of leiomyoma in pregnancy. J. Ayub. Med. Coll. Abbottabad. 2012; 24(1): 90-2.
  22. Fagherazzi S., Borgato S., Bertin M., Vitagliano A., Tommasi L., Conte L. Pregnancy outcome after laparoscopic myomectomy. Clin. Exp. Obstet. Gynecol. 2014; 41(4): 375-9.
  23. Sparić R. Uterine myomas in pregnancy, childbirth and puerperium. Srp. Arh. Celok Lek. 2014; 142(1-2): 118-24.
  24. Seffah J.D., Adu-Bonsaffoh K. Vaginal birth after a previous caesarean section: current trends and outlook in Ghana. J. West Afr. Coll. Surg. 2014; 4(2): 1-25.
  25. Gambacorti-Passerini Z.M., Penati C., Carli A., Accordino F., Ferrari L., Berghella V. Vaginal birth after prior myomectomy. Eur. J. Obstet. Gynecol. Reprod. Biol. 2018; 231: 198-203.
  26. Sutton C., Standen P., Acton J., Griffin C. Spontaneous uterine rupture in a preterm pregnancy following myomectomy. Case Rep. Obstet. Gynecol. 2016; 2016: 6195621.
  27. Bernardi T.S., Radosa M.P., Weisheit A., Diebolder H., Schneider U., Schleussner E. et al. Laparoscopic myomectomy: a 6-year follow-up single-center cohort analysis of fertility and obstetric outcome measures. Arch. Gynecol. Obstet. 2014; 290(1): 87-91.
  28. Vitale S.G., Padula F., Gulino F.A. Management of uterine fibroids in pregnancy: recent trends. Curr. Opin. Obstet. Gynecol. 2015; 27: 432-7.
  29. Senturk M.B., Polat M., Doğan O. et al. Outcome of Cesarean myomectomy: is it a safe procedure? Geburtshilfe Frauenheilkd. 2017; 77(11): 1200-6.
  30. Кондратович Л.М. Клинико-морфологические особенности спаек в брюшной полости у больных миомой матки репродуктивного возраста: Дис.. канд. мед. наук. М.; 2016.

Statistics

Views

Abstract: 173

Article Metrics

Metrics Loading ...

Refbacks

  • There are currently no refbacks.

Copyright (c) 2019 Eco-Vector



This website uses cookies

You consent to our cookies if you continue to use our website.

About Cookies