IMPACT OF UTERINE FIBROIDS ON PREGNANCY OUTCOMES: ANALYSIS FROM A TERTIARY CARE HOSPITAL
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Keywords
Fibroids, pregnancy, fetal outcomes, maternal outcomes, abortions
Abstract
Objective: To assess the prevalence and types of adverse pregnancy outcomes in patients with uterine fibroids at a tertiary care hospital.
Methods: This observational cohort study, conducted at the Department of Obstetrics and Gynecology, Hayatabad Medical Complex Peshawar, Pakistan over a six-month period from November 2023 to April, 2024, aimed to investigate pregnancy outcomes in women with ultrasonography (USG)-documented uterine fibroids. Eligible participants, aged 18 to 40 years, were pregnant women visiting the hospital, excluding those with adnexal pathologies, previous uterine surgery, or obstetrical comorbidities. Retrospective data collection from patient case files ensured confidentiality, covering demographic details, antenatal/intrapartum/postpartum history, clinical examinations, laboratory investigations, USG findings, and obstetric and neonatal outcomes. Statistical analysis utilized descriptive statistics and multiple logistic regression. Ethical considerations included obtaining informed consent, and approval from the Institutional Ethics Committee, ensuring data confidentiality and research integrity.
Results: In this study of 90 pregnant women with uterine fibroids, most were aged 25-32 years, with a significant proportion being primigravida and having a BMI >30. Sub-serous fibroids predominated, mainly located in the fundus. Cesarean section was common, primarily due to PROM and malpresentation. Complications included threatened preterm labor, blood transfusion, and threatened miscarriage. Fetal outcomes showed a high incidence of low birth weight, NICU admission, neonatal resuscitation, and low APGAR scores. Miscarriage, antepartum bleeding, and neonatal mortality were also observed.
Conclusion:
Our study highlights the challenges posed by uterine fibroids during pregnancy, leading to increased risks of complications such as abortion, premature rupture of membranes, and postpartum hemorrhage. While cesarean sections are frequently required, our findings suggest that fibroid characteristics may not consistently predict maternal outcomes. This stresses the need for vigilant monitoring and tailored management strategies to optimize outcomes for both mothers and babies in this high-risk population.
References
2. Freytag, D., Günther, V., Maass, N., & Alkatout, I. (2021). Uterine Fibroids and Infertility. Diagnostics (Basel, Switzerland), 11(8), 1455. https://doi.org/10.3390/diagnostics11081455
3. Choudhary, A., Inamdar, S. A., & Sharma, U. (2023). Pregnancy With Uterine Fibroids: Obstetric Outcome at a Tertiary Care Hospital of Central India. Cureus, 15(2), e35513. https://doi.org/10.7759/cureus.35513
4. InformedHealth.org [Internet]. Cologne, Germany: Institute for Quality and Efficiency in Health Care (IQWiG); 2006-. Overview: Uterine fibroids. [Updated 2021 Jun 10]. Available from: https://www.ncbi.nlm.nih.gov/books/NBK279535/
5. Klatsky, P. C., Tran, N. D., Caughey, A. B., & Fujimoto, V. Y. (2008). Fibroids and reproductive outcomes: a systematic literature review from conception to delivery. American journal of obstetrics and gynecology, 198(4), 357–366. https://doi.org/10.1016/j.ajog.2007.12.039
6. Tîrnovanu, M. C., Lozneanu, L., Tîrnovanu, Ş. D., Tîrnovanu, V. G., Onofriescu, M., Ungureanu, C., Toma, B. F., & Cojocaru, E. (2022). Uterine Fibroids and Pregnancy: A Review of the Challenges from a Romanian Tertiary Level Institution. Healthcare (Basel, Switzerland), 10(5), 855. https://doi.org/10.3390/healthcare10050855
7. Lee, H. J., Norwitz, E. R., & Shaw, J. (2010). Contemporary management of fibroids in pregnancy. Reviews in obstetrics & gynecology, 3(1), 20–27.
8. Gupta, S., & Manyonda, I. T. (2009). Acute complications of fibroids. Best practice & research. Clinical obstetrics & gynaecology, 23(5), 609–617. https://doi.org/10.1016/j.bpobgyn.2009.01.012
9. Yang, Q., Ciebiera, M., Bariani, M. V., Ali, M., Elkafas, H., Boyer, T. G., & Al-Hendy, A. (2022). Comprehensive Review of Uterine Fibroids: Developmental Origin, Pathogenesis, and Treatment. Endocrine reviews, 43(4), 678–719. https://doi.org/10.1210/endrev/bnab039
10. Eltoukhi, H. M., Modi, M. N., Weston, M., Armstrong, A. Y., & Stewart, E. A. (2014). The health disparities of uterine fibroid tumors for African American women: a public health issue. American journal of obstetrics and gynecology, 210(3), 194–199. https://doi.org/10.1016/j.ajog.2013.08.008
11. Guo, X. C., & Segars, J. H. (2012). The impact and management of fibroids for fertility: an evidence-based approach. Obstetrics and gynecology clinics of North America, 39(4), 521–533. https://doi.org/10.1016/j.ogc.2012.09.005
12. Ciavattini, A., Di Giuseppe, J., Stortoni, P., Montik, N., Giannubilo, S. R., Litta, P., Islam, M. S., Tranquilli, A. L., Reis, F. M., & Ciarmela, P. (2013). Uterine fibroids: pathogenesis and interactions with endometrium and endomyometrial junction. Obstetrics and gynecology international, 2013, 173184. https://doi.org/10.1155/2013/173184
13. Outcome of pregnancies with fibroids and its associated complications: a prospective study. Pullemalla SS, Bhargavi B. Asian J Med Res. 2020;9:1–4. [Google Scholar] [Ref list]
14. Obstetric outcomes with large fibroids in pregnancies nearing term: a study in a tertiary care centre in rural india. Dasgupta A, Santra D, Talukdar A, et al. Obstet Gynecol Int J. 2017;7:240–244. [Google Scholar] [Ref list]
15. Adverse obstetric outcomes in pregnant women with uterine fibroids in China: a multicenter survey involving 112,403 deliveries. Zhao R, Wang X, Zou L, Li G, Chen Y, Li C, Zhang W. PLoS One. 2017;12:0. [PMC free article] [PubMed] [Google Scholar] [Ref list]
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Shaima
Consultant Gynecologist at AIMS Sugar and General Hospital, Hayatabad, Pakistan
Hina Tariq Jan
Senior Registrar, Department of Psychiatry, Frontier Corps Teaching Hospital, Peshawar, Pakistan
Lubna Aslam
Associate Professor, Obstetrics and Gynecology, PGMI/AMC/LGH, Lahore, Pakistan
Faiza Ali
House Officer, DHQ Teaching Hospital, Dera Ismail Khan, Pakistan
Muniba Gul
House Officer, Hayatabad Medical Complex, Peshawar, Pakistan
Muhammad Haider Ali
MBBS, MD, Resident Surgeon, Hayatabad Medical Complex, Peshawar, Pakistan