{"title":"子宫肌瘤大小对围产期和新生儿结局的影响:651例妊娠的单中心队列研究","authors":"Ruken Dayanan, Dilara Duygulu Bulan, Merve Ayas Ozkan, Gulsan Karabay, Zeynep Seyhanli, Eda Beydilli Sural, Feyza Basmaz, Seda Kunt, Sevki Celen","doi":"10.1186/s12887-025-06133-2","DOIUrl":null,"url":null,"abstract":"<p><strong>Objective: </strong>To evaluate the impact of fibroid size on maternal and neonatal outcomes, determine whether a dose-response pattern exists across size categories (< 5 cm, 5-10 cm, > 10 cm), and identify a threshold at which pregnancy risk increases significantly.</p><p><strong>Methods: </strong>This retrospective cohort study included 651 pregnant women with sonographically confirmed uterine fibroids. Participants were stratified into three groups based on the maximum diameter of the largest fibroid: <5 cm, 5-10 cm, and > 10 cm. Outcomes assessed included preterm birth, PPROM, malpresentation, caesarean delivery, postpartum haemorrhage (PPH), fetal growth restriction (FGR), NICU admission, miscarriage, surgical outcomes such as operative time and blood loss, and a composite adverse perinatal outcome (CAPO). Logistic regression analysis was performed to identify variables independently associated with CAPO.</p><p><strong>Results: </strong>Adverse events rose stepwise with fibroid size. Preterm birth occurred in 12.3%, 24.1% and 36.1% of the size groups (p < 0.001); PPROM in 2.5%, 10.6% and 13.9% (p < 0.001); malpresentation in 13.3%, 28.6% and 47.2% (p < 0.001). Caesarean deliveries were 56.6%, 67.3% and 92.1%, while PPH rose from 1.3 to 30.6% (both p < 0.001). Operative blood loss and time likewise increased with diameter. Neonatally, mean birthweight declined (3150 g, 2995 g, 2870 g; p = 0.003); NICU admission rose from 13.5 to 34.1% (p < 0.001), and CAPO from 14.8 to 35.1% (p < 0.001). Multivariate analysis showed that fibroids > 5 cm independently predicted CAPO (aOR: 1.84 for 5-10 cm; 3.78 for > 10 cm), while maternal age, parity, IVF were not significant. Descriptive subgroup analysis revealed longer operative times and greater blood loss in women with multiple, cervical, or combined-type fibroids.</p><p><strong>Conclusion: </strong>Fibroid diameter emerged as a key determinant of obstetric and neonatal risk. Lesions > 5 cm, particularly > 10 cm, were associated with markedly increased rates of maternal haemorrhage, preterm birth, and neonatal morbidity. Such pregnancies should be managed as high-risk, with enhanced antenatal surveillance and individualized delivery planning.</p>","PeriodicalId":9144,"journal":{"name":"BMC Pediatrics","volume":"25 1","pages":"750"},"PeriodicalIF":2.0000,"publicationDate":"2025-10-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12492596/pdf/","citationCount":"0","resultStr":"{\"title\":\"Influence of uterine fibroid size on perinatal and neonatal outcomes: a single-centre cohort of 651 pregnancies.\",\"authors\":\"Ruken Dayanan, Dilara Duygulu Bulan, Merve Ayas Ozkan, Gulsan Karabay, Zeynep Seyhanli, Eda Beydilli Sural, Feyza Basmaz, Seda Kunt, Sevki Celen\",\"doi\":\"10.1186/s12887-025-06133-2\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Objective: </strong>To evaluate the impact of fibroid size on maternal and neonatal outcomes, determine whether a dose-response pattern exists across size categories (< 5 cm, 5-10 cm, > 10 cm), and identify a threshold at which pregnancy risk increases significantly.</p><p><strong>Methods: </strong>This retrospective cohort study included 651 pregnant women with sonographically confirmed uterine fibroids. Participants were stratified into three groups based on the maximum diameter of the largest fibroid: <5 cm, 5-10 cm, and > 10 cm. Outcomes assessed included preterm birth, PPROM, malpresentation, caesarean delivery, postpartum haemorrhage (PPH), fetal growth restriction (FGR), NICU admission, miscarriage, surgical outcomes such as operative time and blood loss, and a composite adverse perinatal outcome (CAPO). Logistic regression analysis was performed to identify variables independently associated with CAPO.</p><p><strong>Results: </strong>Adverse events rose stepwise with fibroid size. Preterm birth occurred in 12.3%, 24.1% and 36.1% of the size groups (p < 0.001); PPROM in 2.5%, 10.6% and 13.9% (p < 0.001); malpresentation in 13.3%, 28.6% and 47.2% (p < 0.001). Caesarean deliveries were 56.6%, 67.3% and 92.1%, while PPH rose from 1.3 to 30.6% (both p < 0.001). Operative blood loss and time likewise increased with diameter. Neonatally, mean birthweight declined (3150 g, 2995 g, 2870 g; p = 0.003); NICU admission rose from 13.5 to 34.1% (p < 0.001), and CAPO from 14.8 to 35.1% (p < 0.001). Multivariate analysis showed that fibroids > 5 cm independently predicted CAPO (aOR: 1.84 for 5-10 cm; 3.78 for > 10 cm), while maternal age, parity, IVF were not significant. Descriptive subgroup analysis revealed longer operative times and greater blood loss in women with multiple, cervical, or combined-type fibroids.</p><p><strong>Conclusion: </strong>Fibroid diameter emerged as a key determinant of obstetric and neonatal risk. Lesions > 5 cm, particularly > 10 cm, were associated with markedly increased rates of maternal haemorrhage, preterm birth, and neonatal morbidity. Such pregnancies should be managed as high-risk, with enhanced antenatal surveillance and individualized delivery planning.</p>\",\"PeriodicalId\":9144,\"journal\":{\"name\":\"BMC Pediatrics\",\"volume\":\"25 1\",\"pages\":\"750\"},\"PeriodicalIF\":2.0000,\"publicationDate\":\"2025-10-03\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12492596/pdf/\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"BMC Pediatrics\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1186/s12887-025-06133-2\",\"RegionNum\":3,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q2\",\"JCRName\":\"PEDIATRICS\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"BMC Pediatrics","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1186/s12887-025-06133-2","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"PEDIATRICS","Score":null,"Total":0}
引用次数: 0
摘要
目的:评估子宫肌瘤大小对孕产妇和新生儿结局的影响,确定不同大小类别(10cm)是否存在剂量-反应模式,并确定妊娠风险显著增加的阈值。方法:回顾性队列研究纳入651例超声确诊子宫肌瘤的孕妇。参与者根据最大肌瘤的最大直径分为三组:10厘米。评估的结局包括早产、PPROM、分娩不良、剖宫产、产后出血(PPH)、胎儿生长受限(FGR)、NICU入院、流产、手术结局(如手术时间和出血量)和综合不良围产期结局(CAPO)。进行逻辑回归分析以确定与CAPO独立相关的变量。结果:不良事件随肌瘤大小逐渐增加。早产发生率分别为12.3%、24.1%和36.1% (p 5 cm独立预测CAPO (5-10 cm aOR: 1.84; > -10 cm aOR: 3.78),而母亲年龄、胎次、体外受精无显著性差异。描述性亚组分析显示,多发性、子宫颈或混合型肌瘤患者手术时间更长,出血量更大。结论:子宫肌瘤直径是产科和新生儿风险的关键决定因素。bbb5 cm的病变,特别是>0 cm的病变,与产妇出血、早产和新生儿发病率显著增加相关。此类妊娠应作为高危妊娠进行管理,并加强产前监测和个性化分娩计划。
Influence of uterine fibroid size on perinatal and neonatal outcomes: a single-centre cohort of 651 pregnancies.
Objective: To evaluate the impact of fibroid size on maternal and neonatal outcomes, determine whether a dose-response pattern exists across size categories (< 5 cm, 5-10 cm, > 10 cm), and identify a threshold at which pregnancy risk increases significantly.
Methods: This retrospective cohort study included 651 pregnant women with sonographically confirmed uterine fibroids. Participants were stratified into three groups based on the maximum diameter of the largest fibroid: <5 cm, 5-10 cm, and > 10 cm. Outcomes assessed included preterm birth, PPROM, malpresentation, caesarean delivery, postpartum haemorrhage (PPH), fetal growth restriction (FGR), NICU admission, miscarriage, surgical outcomes such as operative time and blood loss, and a composite adverse perinatal outcome (CAPO). Logistic regression analysis was performed to identify variables independently associated with CAPO.
Results: Adverse events rose stepwise with fibroid size. Preterm birth occurred in 12.3%, 24.1% and 36.1% of the size groups (p < 0.001); PPROM in 2.5%, 10.6% and 13.9% (p < 0.001); malpresentation in 13.3%, 28.6% and 47.2% (p < 0.001). Caesarean deliveries were 56.6%, 67.3% and 92.1%, while PPH rose from 1.3 to 30.6% (both p < 0.001). Operative blood loss and time likewise increased with diameter. Neonatally, mean birthweight declined (3150 g, 2995 g, 2870 g; p = 0.003); NICU admission rose from 13.5 to 34.1% (p < 0.001), and CAPO from 14.8 to 35.1% (p < 0.001). Multivariate analysis showed that fibroids > 5 cm independently predicted CAPO (aOR: 1.84 for 5-10 cm; 3.78 for > 10 cm), while maternal age, parity, IVF were not significant. Descriptive subgroup analysis revealed longer operative times and greater blood loss in women with multiple, cervical, or combined-type fibroids.
Conclusion: Fibroid diameter emerged as a key determinant of obstetric and neonatal risk. Lesions > 5 cm, particularly > 10 cm, were associated with markedly increased rates of maternal haemorrhage, preterm birth, and neonatal morbidity. Such pregnancies should be managed as high-risk, with enhanced antenatal surveillance and individualized delivery planning.
期刊介绍:
BMC Pediatrics is an open access journal publishing peer-reviewed research articles in all aspects of health care in neonates, children and adolescents, as well as related molecular genetics, pathophysiology, and epidemiology.