The effect of the myoma uteri on pregnancy outcomes

Uterine leiyomyoma is the most common benign tumor of the uterus and if associated with pregnancy may adversely affect the outcome of pregnancy. In the last 20-30 years, there has been a delay in first-time pregnancies, and the average age of women at the time of delivery has increase in many countries. The presence of myomas was significantly associated with women`s age over 35 years old. The aim of this thesis was to determine the prevalence, clinical presentation, maternal and fetal outcomes of birth among pregnant women with myoma. This retrospective cohort study was conducted in the University of Cukurova School of Medicine, Department of Obstetric and Gynecology from 24 October 2014 to 30 June 2018. In the study were included 191 women with myoma and 201 women without myoma who underwent at least one ultrasonogrphic examination in our centre. Potential confounding variables, including maternal age, parity, gestational age, size of myoma, complications during pregnancy, labour and mode of delivery were noted. The main complications for the mother were myomectomy in pregnancy, retained placenta and bleeding. Fetal complications were premature rupture of membrane, İUGG, premature delivery, oligohidramnioz, malpresentation and fetal death. During the study period 18564 patients were examined in prenatal center. According to this data the prevalence of myoma in pregnant females in our center was 10.88%. The age range of patients was between 21 and 48 and the median age was 36. The patients were divided in two groups: women with myoma and women without myoma. And women with myoma were divided further in two groups; women with and without complications. Among the most common maternal complication were myomektomi 5 (2.4%), retained placenta 4 (1.9%), bleeding 4 (1.9%). Fetal complications were EMR 7 (3.5%), premature delivery 4 (2%), oligohidramnioz 12 (6%), İUGG 6 (3%), malpresantation 2 (1%) and fetal death 2 (1%). 46 patients (24.1%) had complications and 11 (5.8%) patients had two complications. Neonatal pediatric intensive care unit admission were 22 (11%.). Fetal complications; gestational week of delivery, 5. minute APGAR score, birth weight and height were found statistically important in complication group. For gestational week of delivery values were 38.4 wks vs.37.2wks; p<0,05. For birth weight were 3.308,6gr vs. 3.015,2gr: p<0,05. For height data were 49.9cm vs 48.8cm: p<0,05. Total volume of myoms (638.070,8mm3 vs. 1.172.835,8 mm3; p<0.05), diameter of the biggest myom (43.6mm vs. 54.9mm; p<0.05), sum of the largest diameters of myoms (56.8mm vs 74.7mm; p<0.05), average of the largest diameters of myoms (40,0mm vs.48.7mm; p<0.05) all affected the number of admissions to the neonatal pediatric intensive care unit. These results show us that the presence of myoma mostly affect fetal rather than mother health. Even most of myomas in pregnancy are asymptomatic but may be associated with some complications affecting the course of pregnancy and labour. Uterine myomas increase the risk of adverse pregnancy outcomes, thus emphasizing the importance of appropriate intrapartum management of these high risk pregnancies.