Features of pregnancy, childbirth and postpartum in women with uterine leiomyoma

Abstract

The objective: to determine the effect of uterine fibroid on the features of pregnancy, childbirth and possible complications during pregnancy delivery and postpartum. Materials and methods. We analyzed 10684 histories of pregnancy and childbirth for 3 years (2019–2021). The main group of pregnant women included 363 cases with fibroid (3.39% of the total). The comparison group consisted of pregnant women without fibroid (10,321 births (96.61% of total)). Results. We found that the following factors as the age of the pregnant woman, high BMI, smoking and alcohol consumption were of significant risk (p<0.05) regarding the fibroid progression and its effect on the course of pregnancy, which affected the development of gestational diabetes and hypertensive disorders in pregnant women with fibroid. The rate of delivery by caesarean section in women with fibroid reached 59.0% compared with 23.4% in the group without fibroid (p<0.001). An association between fibroid and an increased risk of caesarean section was confirmed (OR 4.7; 95% CI: 3.8–5.8). The size of the fibroid node significantly increased the likelihood of placentation pathology as placenta previa in the subgroup with the size of the node >5 cm, the likelihood of preterm birth, as well as the volume of postpartum hemorrhage (p<0.05). The fibroid node type proved a statistically significant effect on the incidence of placental abruption, especially in the case of placental attachment close to the submucosal node compared with another type of nodes (intramural or subserous) – 6.9% vs. 0.8% respectively in the case of intramural fibroid and 0% for subserous fibroid p<0.01. Conclusions. According to the results of a retrospective study, we proved that pregnant women with uterine fibroid are at greater risk of complications of pregnancy, childbirth and the postpartum period. There is a direct relationship between pregnancy in the background of fibroid and the likelihood of placenta previa, increased frequency of caesarean section and the development of postpartum hemorrhage.The relationship between different characteristics of the uterine fibroid (its type, size, localization, number of nodes) and the likelihood of massive obstetric bleeding has been proven. We focus on the aspect of prognosis, determination by obstetrician-gynecologists of a high-risk group for developing postpartum hemorrhage in pregnant women with uterine leukemia for the purpose of timely prevention and treatment of massive obstetric hemorrhage and the development of coagulopathic disorders.