Adverse obstetric outcomes associated with sonographically identified large uterine fibroids

Literature Review Article

Adverse obstetric outcomes associated with sonographically identified large uterine fibroids. Shavell VI, Thakur M, Sawant A, Kruger ML, Jones TB, Singh M, Puscheck EE, Diamond MP. Fertil Steril. 2012 June; 97(1): 107-110. 

Reviewed by Dr. John Preston Parry, M.D., M.P.H.

The goal of the study was to assess the effect of large fibroids on common obstetrical outcome metrics. This retrospective study looked at women at less than 20 weeks of pregnancy and stratified them based on fibroid size and number. Findings included higher rates of PPROM, preterm delivery, blood loss at delivery, and need for postpartum transfusion. PPROM occurred in 1.9% of participants without fibroids (or less than 5 cm), 8.3% of women with one fibroid >5 cm, and 25% of women with two fibroids >5 cm. [Of note, 100% of those with three fibroids >5 cm had PPROM. Small fibroids did not increase the risk for preterm delivery (38.6 weeks in those without vs. 38.4 weeks in those with fibroids <5 cm), but those with large (>5 cm) fibroids averaged delivery at 36.5 weeks. A dose response effect was observed for average blood loss (487 mL vs. 536 mL vs. 645 mL for no vs. small vs. large fibroids). Finally, those with large fibroids had much greater risk for postpartum transfusion (12.2%) relative to those with small (0%) or no (1.1%) fibroids. All of these findings were statistically significant.

Comments by Dr. Steven R. Lindheim, M.D. 

The study concludes that large fibroids can be detrimental to pregnancy. However, additional studies will be needed to show whether myomectomy reduces the risk of these outcomes.

The above review and commentary on this article were written by SRS members. Publication of these summaries does not reflect endorsement of any particular procedure or treatment. Views expressed in these summaries do not necessarily reflect the views of SRS or ASRM. 

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