Clinical Treatment Of Pregnancies Associated With Leiomyomas

OBJECTIVE:The study is to investigate the possibility and safety to have a baby for women who suffer from uterine fibroids, the effect of myomas on gravidity and labor, and how to treat with myomas in the different pregnant periods.METHODS:We collect 209 cases of pregnant women with myomas in the department of gynecology and obstetrics in Shandong Provincial Hospital between January 1993 and January 2011. We analyze the complications of the cases, like threatened abortion, threatened premature labor, abnormal fetal position, placenta previa, fetal distress, premature rupture of membrane, macrosomia, red degeneration of myomas, postpartum hemorrhage, neonatal asphyxia and so on. Through comparing the rates of complications between normal pregnancies and pregnancies with myomas, we investigate the effect of myomas on pregnancy. The 209 cases are divided into different groups according to the number, the position and the diameters of the myomas. Compare the groups and search whether different myomas have different effects on pregnancy or not. We analyze the indexes of myomectomy during cesarean section like bleeding, postnatal infection and so on, to find the optimal treatment of myomas during cesarean section.RESULTS: 1. There is no obvious difference between the searched object and the normal rate in complications in pregnancy, labor and delivery, except for abnormal fetal position.2. Of all the 209 cases,189 cases(95.9%) terminate pregnancies by cesarean section, while 8 cases(4.1%) by spontaneous delivery.2 cases is threatened abortion.3 embryos stop growing.1 case is spontaneous abortion.5 cases have symptomatic red degeneration during the gestational period. The rate of cesarean section is obviously elevated.3. Of all the 209 cases, only 5 cases have symptomatic red degeneration(2.39 %). Of the 5 cases, one case is cured just by drugs, the other four cases by myomectomy. Of the 189 cesarean section cases,94 cases(49.7%) have red degeneration, of which 26 cases have abdominal pain and fever during the 16-24 gestational weeks. The abdominal pain is not severe and the fever is less than 39℃. All of the 26 cases are not hospitalized. The symptoms remit after 4 days or so, disappear about two weeks later.17 cases have other kinds of degeneration, like hyaline degeneration, cystic degeneration, degeneration with calcification, and so on. All of the 111 cases'degeneration is diagnosed by pathology.4. Myomectomy is feasible during cesarean section. It doesn't elevate the rate of postnatal infection, length of stay and operation bleeding.CONCLUSIONS:1. Women of reproductive age can try to be fertilized with myomas. It is not a must to excise myomas before conception, unless the myoma is so big that it changes morphology of uterine cavity or the myoma lies in the cavity, which causes infertility or repeated spontaneous abortions.2.The rate of red degeneration in the gestation period is not low. Part of the red degeneration cases have no symptoms, part of the cases have abdominal pain, fever or vomit, which are not serious and disappear two weeks later. Only a few cases have severe symptoms that can be cured by drugs or myomectomy. 3. The rate of cesarean section rises in pregnancies complicated leiomyomas. Some of the gravida with myomas value the fetus. For medical reasons, myomas can cause abnormal fetal positions, uterine inertia in delivery, and dystocia, so the indication of cesarean section can be broadened.4. Myomectomy is feasible and necessary during cesarean section. It doesn't elevate the volume of bleeding to excise a myoma which is not smaller than five centimeters. It is significant, because excising myomas can avoid bad involution of uterus, shorten lochia time, and avoid secondary infection. At the same time, the patients are exempted the secondary operation, which reduces the cost.