Leiomyomas in pregnancy

Ana Maria Huszti, A. Ciobanu, C. Gică, Mihaela Demetrian, B. Cimpoca-Raptis, G. Peltecu, R. Botezatu, N. Gică, A. Panaitescu
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Abstract

Uterine fibroids are the most common benign tumors affecting female genital tract, responsible for a high morbidity across fertile age women, with a prevalence of 0,1-11% among pregnant women. Although generally asymptomatic, they can lead to a series of symptoms and complications such as pain, infertility, miscarriages, antenatal bleeding, postpartum hemorrhage, preterm labor, fetal malpresentation, placental abruptio and high cesarean section rates. The purpose of review is to update information regarding fibroids specifications and their correlation with pregnancy outcomes as well as fibroids management during pregnancy. Because of uterine fibroids heterogeneity and lack of large, randomized trials there are encountered discrepancies among studies, but it was observed that uterine fibroids increase the risks of negative obstetrical outcomes, especially when it goes to large, multiple, submucous and retroplacental myomas. Conservative management during pregnancy is advised, but in special situations myomectomy could be recommended and possible. Trial of labor should be offered to pregnant women even if they have large uterine fibroids, or previous myomectomy excepting fibroids obstructing the birth canal or patients who underwent extensive surgery for fibroids removal.
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妊娠期平滑肌瘤
子宫肌瘤是影响女性生殖道的最常见的良性肿瘤,在育龄妇女中发病率很高,在孕妇中患病率为0.1% -11%。虽然一般无症状,但可导致一系列症状和并发症,如疼痛、不孕、流产、产前出血、产后出血、早产、胎儿畸形、胎盘早剥和剖宫产率高。回顾的目的是更新有关子宫肌瘤规格及其与妊娠结局的相关性以及妊娠期间子宫肌瘤的处理的信息。由于子宫肌瘤的异质性和缺乏大型随机试验,研究之间存在差异,但观察到子宫肌瘤增加了不良产科结局的风险,特别是当它发展为大型、多发性、粘膜下和胎盘后肌瘤时。建议在怀孕期间保守处理,但在特殊情况下,子宫肌瘤切除术是可行的。孕妇即使有较大的子宫肌瘤,或有子宫肌瘤切除史,但子宫肌瘤阻塞产道者除外,或接受过子宫肌瘤切除手术的患者,也应进行试产。
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