| Objective: Through the diagnosis of pregnancy with uterine fibroids,the choice of delivery mode and prognosis,we analyze the feasibility of spontaneous delivery of different parts of uterine fibroids,and explore the feasibility of myomectomy during cesarean section in patients with pregnancy complicated with uterine myoma.Methods: We select 136 cases of pregnancy complicated with uterine fibroids in First Hospital Affiliated to Suzhou University from October 2012 to October 2016.Different delivery methods were selected according to the location,size,quantity of uterine fibroids and patient factors.And we observe the amount of bleeding in different delivery modes and so on.At the same time,130 patients having no uterine fibroids who were hospitalized in the same period were selected as control group.By contrasting,we analyze the effect of uterine fibroids on the labor and postpartum hemorrhage and compare the amount of intraoperative blood loss,the difference of hemoglobin before and after operation,and the length of hospital stay.Results:1.In patients with pregnancy complicated with uterine fibroids,There were 8 cases of uterine fibroids located in the lower uterine segment(including cervical myoma).There were 127 cases of uterine fibroids located in the uterine body(including fibroids located at the bottom of the uterus).There was 1 case of uterine fibroids in the uterine horn.There were 4 cases of subserosal myoma.There were 2 cases submucosal myoma.There were 57 cases of uterine fibroids greater than 5cm.There were 79 cases uterine fibroids less than or equal to 5cm.2.Of the uterine fibroids located in the lower uterine segment(including cervical myoma), there were 8 cases of cesarean section and 0 cases of spontaneous labor.Of the uterine fibroids located in the uterine body(including fibroids located at the bottom of the uterus),there were 66 cases of cesarean section,58 cases of spontaneous labor,2 cases of late abortion and 1 case of induction of labor.Of the uterine fibroids in the uterine horn,there was 1 case of cesarean section and 0 cases of spontaneous labor.3.Of the uterine fibroids greater than 5cm,there were 32 cases of cesarean section and 23 cases of spontaneous labor.Of the uterine fibroids less than or equal to 5cm,there were 43 cases of cesarean section and 35 cases of spontaneous labor.4.In the operation of cesarean section myomectomy,the average blood loss was 307.4 ±30.09 ml in patients with uterine fibroids less than or equal to 5cm,the average blood loss was 346.4±26.96 ml in patients with uterine fibroids equal to 5-8cm,and the average blood loss was 550.0±112.1ml in patients with uterine fibroids greater than 8cm.There was a significant statistically difference of the mean bleeding volume between patients with uterine fibroids greater than or equal to 8cm and patients with uterine fibroids less than or equal to 5cm(P<0.05).There was no significant difference in mean bleeding volume between patients with uterine fibroids 5-8cm and patients with uterine fibroids less than or equal to 5cm(P>0.05).The average blood loss was 316.1±20.59 ml in patients with uterine fibroids located in the uterine body(including fibroids located at the bottom of the uterus).The average blood loss was 781.3±206.6ml in patients with uterine fibroids located in the lower uterine segment(including cervical myoma).The average blood loss was 600 ml in patients with uterine fibroids located in the uterine horn.There was a significant statistically difference in the latter two with patients with uterine fibroids located in the uterine body(including fibroids located at the bottom of the uterus)(P<0.05).5.In the pantients of vaginal delivery,the average blood loss of 2 hours after parturition was 215.6±5.775 ml in patients with uterine fibroids less than or equal to 5cm,the average blood loss was 374.6±72.82 ml in patients with uterine fibroids 5-8cm.And the average blood loss was 240.0±22.97 ml in patients with uterine fibroids greater than or equal to 8cm.There was a statistically difference of blood loss of 2 hours after parturition between patients with uterine fibroids 5-8cm and patients with uterine fibroids less than or equal to 5cm(P<0.05).There was no significant difference of blood loss of 2 hours after parturition between patients with uterine fibroids greater than or equal to 8cm and patients with uterine fibroids less than or equal to 5cm(P>0.05).This may be related to that the number of uterine fibroids greater than or equal to 8cm is smaller and the use of uterotonic Hemabate after delivery.6.In the pantients of vaginal delivery of the study group,the average blood loss of 2 hours after parturition of the primipara was 288±35.43 ml.In the control group,the average blood loss of 2 hours after parturition of the primipara was 210.4±6.372 ml.There was a significant statistically difference between the two groups(P<0.05).There was no significant difference in the average blood loss of 2 hours after parturition of the pluripara between the two groups.There was no significant difference of the average labor time of the primipara between the two groups.And there was no significant difference of the average labor time of the pluripara between the two groups too.In the cesarean section,there was a significant statistically difference of the average intraoperative blood loss,preoperative and postoperative hemoglobin difference and postoperative hospital stay between the two groups.Conclusions:1.The location of uterine fibroids may have a direct impact on the choice of delivery mode.You can choose the vaginal trial production when there is no uterine fibroids located in the lower uterine segment or cervical myoma or the myoma blocking the birth canal and there is no obstetric factors of cesarean section indications existing.2.Uterine fibroids are not the absolute surgical indications of cesarean section.When there is uterine fibroids blocking the birth canal,it is recommended that cesarean delivery.3.Uterine fibroids had no significant effect on the duration of vaginal delivery.There was no forceps delivery or other dystocia in the study group.4.The size of uterine fibroids was correlated with the amount of bleeding.With the increase in the size of uterine fibroids,the amount of bleeding may increase,especially in the cesarean section.The amount of bleeding of large uterine fibroids located in the cervix or the lower uterine segment was significantly more than the uterine fibroids located in the uterine body or the bottom of the uterus.5.It is feasible to perform myomectomy during cesarean section,but needing a synthetic judgment according to the location,size and whether there are other risk factors. |
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