Pregnancy Outcome Analysis Of Vaginal Delivery In Primipara With Uterine Fibroids

Objective:To analyze the labor process characteristics,pregnancy outcome and neonatal prognosis of primipara with uterine fibroids during vaginal delivery,and to explore the reasonable mode of delivery and the prevention of related complications,so as to provide theoretical basis for clinical obstetricians in perinatal management of pregnancy complicated with uterine fibroids.Materials and Methods:A retrospective study was performed in Fujian Provincial Maternity and Children’s Hospital From January 2014 to October 2020,a total of 3016 primiparas with vaginal delivery of cephalic presentation and single fetus were selected,which was divided into myoma group(n=754)and normal group(n=2262)According to whether uterine fibroids were combined or not.The basic data,the situation of production process,the probability of obstetric complications and neonatal outcomes between the two groups were analyzed.Moreover,the further discussion on the influence of the labor process characteristics,pregnancy outcome and neonatal prognosis of primipara with uterine fibroids during vaginal delivery from four aspects of uterine fibroids,such as size(≦2cm,2-5cm,≧5cm),number(single,multiple≧2),location(uterine fundus/uterine body fibroids,the lower uterine segment fibroids),type(subserous fibroids,submucosal fibroids,intramural fibroids).SPSS 24.0software was used for statistical analysis.Results :1.The incidences of premature rupture of membranes(PROM),gestational diabetes mellitus(GDM),preeclampsia and postpartum hemorrhage(PPH)in the myoma group were significantly higher than those in the normal group(P<0.05),while there was no significant difference in the incidence of persistent occiput transverse/posterior position or placental abruption between the two groups(P>0.05).2.The proportion of premature infant and low birth weight infant(LBWI)in fibroid group was significantly higher than those in normal group,furthermore,oneminute Apgar score after birth was lower than that in normal group(P< 0.05).There was no significant difference in the birth weight,five-minute Apgar score after birth,the proportion of small for gestational age(SGA),fetal distress in uterus,umbilical cord around neck,neonatal asphyxia,or neonatal admission rate between the two groups(P>0.05).3.The duration of the first,second and total stage of labor in the myoma group were all significantly longer than those in the normal group,the rate of obstetrical forceps delivery and manual removal of placenta,the amounts of hemorrhage within 2hours after delivery,The usage rate of strong contraction agent(carbetocin,carboprost trometamol)in the myoma group were also higher(P<0.05).However,there was no significant difference in the duration of the third stage of labor or the percentage of artificial rupture of membranes between the two groups(P> 0.05).4.Effect of myoma size: With the increase of the maximum diameter of fibroids,The duration of the first,second and total stage of labor gradually extended.In addition,when the maximum diameter of fibroids≥5cm,the incidence of PROM,PPH,preterm labor(PTL)and LBWI increased markedly(P<0.05).There was no significant correlation between the morbidity of GDM,preeclampsia or the length of the third stage of labor(P>0.05).5.Effect of myoma number: The duration of the first and total stage of labor in the multiple myoma group were significantly prolonged,and the incidences of PROM,GDM and preeclampsia were higher than those in the single myoma group(P<0.05).However,there was no significant correlation between the number of fibroids and the incidence of PPH,PTL,LBWI or the length of the second and third stages of labor(P>0.05).6.Effect of myoma location: The duration of the first,second and total stage of labor in the lower uterine segment myoma group were longer than those in the uterine fundus/uterine body myoma group,and the incidence of PPH in the lower uterine segment myoma group was also significantly increased(P<0.05).There was no significant difference in the incidence of PROM,GDM,preeclampsia,PTL,LBWI and the length of the third stage of labor between the two groups(P>0.05).7.Effect of myoma type: The incidence of PROM,GDM,preeclampsia,PPH,PTL,LBWI and the length of each stage of labor had no significant correlation with fibroid type(P>0.05).Conclusions:1.The risk of some obstetric complications increases in primipara with uterine fibroids during perinatal period.Therefore,once patients with uterine fibroids are pregnant,regular prenatal examination should be carried out.Especially pregnant women with larger uterine fibroids(≧ 5cm),multiple uterine fibroids and lower uterine segment fibroids should pay more attention to prevent obstetric complications in advance.The obstetric complications that have occurred should be handled in time to ensure the safety of mothers and infants.2.Uterine fibroids,especially with larger fibroids(≧5cm),can increase the risk of premature infants and low birth weight infants.3.Vaginal delivery of the primipara with uterine fibroids,especially those with larger uterine fibroids(≧5cm)and lower uterine segment fibroids,can prolong the labor process,increase the risk of instrumental midwifery and PPH.Strictly controlling the indication of the vaginal trial delivery and closely monitoring the production process for pregnant women with Uterine fibroids.If necessary,timely intervention in the labor process to reduce the occurrence of adverse outcomes of mothers and infants.