Journal of South Asian Federation of Obstetrics and Gynaecology

Register      Login

VOLUME 16 , ISSUE 1 ( January-February, 2024 ) > List of Articles


Pregnancy-associated Leiomyomas: What is New?

Mohsen MA Abdelhafez, Karim AM Ahmed, Win Win Than, Mohd Nazri Mohd Daud, Mohamad Saffree Jeffree, Fairrul MA Kadir, DG Marshitah PG Baharuddin, Firdaus Hayti, Nornazirah Azizan, Doreen Sumpat, Aya AM Eldiastey

Keywords : Caesarean myomectomy, Fetal congenital heart block, Fetal growth scan, Hysterolaparoscopy, Morbidly adherent placenta, Ovarian tumors, Pregnancy outcomes, quality of life, Uterine artery embolization, Uterine fibroids

Citation Information : Abdelhafez MM, Ahmed KA, Than WW, Mohd Daud MN, Jeffree MS, Kadir FM, Baharuddin DM, Hayti F, Azizan N, Sumpat D, Eldiastey AA. Pregnancy-associated Leiomyomas: What is New?. J South Asian Feder Obs Gynae 2024; 16 (1):29-33.

DOI: 10.5005/jp-journals-10006-2321

License: CC BY-NC 4.0

Published Online: 10-01-2024

Copyright Statement:  Copyright © 2024; The Author(s).


Aims: Owing to the continuous debate and dilemma regarding the appropriate approach for managing fibroids with pregnancy, this review aims to synthesize, analyze and build up evidence from the published studies, especially the recent ones, about the changing trends in the last decade regarding the management of uterine fibroids with pregnancy and the feasibility as well as safety of cesarean myomectomy in comparison to the traditional conservative approach of deferring removal of the fibroids 3–6 months post-partum. Materials and methods: This is a review of the literature, and all the co-authors searched for, gathered, and filtered the most recent publications on the subject through PubMed, Medline, Google search, and others. Findings: The prevalence of fibroids with pregnancy ranges between 0.1 and 3.9% however, the true rate may be higher than this presently reported incidence. Discussion: An increasing trend in diagnosing fibroids with pregnancy is currently clearly obvious, mainly due to the concept of delaying child-bearing as well as the steady increase in the rate of cesarean delivery which leads to more incidental findings of asymptomatic fibroids. Conclusions: Uterine fibroids in pregnancy represent a dilemma in both diagnosis and treatment. Ultrasonography remains the main diagnostic modality for fibroids during pregnancy despite its reduced sensitivity and specificity during pregnancy. Treatment of fibroids with pregnancy continues to be a matter of debate and controversy, where traditionally myomectomy used to be deferred until after delivery and maybe after puerperium. At present both caesarean myomectomy and also, myomectomy during pregnancy have places in modern obstetrics. Statement of significance: • The problem regarding the association of fibroids with pregnancy arises mainly from the challenges in both the diagnosis, where ultrasonography has a reduced sensitivity and specificity during pregnancy, as well as the controversy and debate in the treatment strategies of the condition. • The traditional known practice of managing fibroids in association with pregnancy, is to postpone the removal of fibroids until postnatal and even after puerperium to allow a time for uterine involution and shrinkage of the fibroid hence, minimizing the operative time and the associated blood loss with the potential risks of spontaneous miscarriage, placental dysfunction, fetal malpresentations and preterm birth especially with submucous and intramural fibroids. • This article highlighted the newly introduced interventions in the context of the management of fibroids with pregnancy including, techniques to prevent preterm delivery and achieve term birth in case of treatment delay until post-delivery, or the implementation of cesarean myomectomy as well as myomectomy during pregnancy.

  1. Vergani P, Locatelli A, Ghidini A, et al. Large uterine leiomyomata and risk of cesarean delivery. Obstet Gynecol 2007;109(2 Pt 1):410–414. DOI: 10.1097/01.AOG.0000250470.78700.f0.
  2. Wise LA, Laughlin-Tommaso SK. Epidemiology of uterine fibroids: From menarche to menopause. Clin Obstet Gynecol 2016;59(1):2–24. DOI: 10.1097/GRF.0000000000000164.
  3. Ciavattini A, Delli Carpini G, Clemente N, et al. Growth trend of small uterine fibroids and human chorionic gonadotropin serum levels in early pregnancy: An observational study. Fertil Steril 2016;105(5):1255–1260. DOI: 10.1016/j.fertnstert.2016.01.032.
  4. Munro MG, Critchley HO, Broder MS, et al. FIGO working group on menstrual disorders. FIGO classification system (PALM-COEIN) for causes of abnormal uterine bleeding in nongravid women of reproductive age. Int J Gynaecol Obstet 2011;113(1):3–13. DOI: 10.1016/j.ijgo.2010.11.011.
  5. Cook H, Ezzati M, Segars JH, et al. The impact of uterine leiomyomas on reproductive outcomes. Minerva Gineco 2010;62(3):225–236. PMID: 20595947.
  6. Abdullah RK, Massey IY, Liu N, et al. The differences in characteristics of uterine leiomyomas and the diverse adverse pregnancy outcomes. J Obstet Gynaecol 2021;41(6):841–847. DOI: 10.1080/01443615.2020.1846020.
  7. Qidwai GI, Caughey AB, Jacoby AF. Obstetric outcomes in women with sonographically identified uterine leiomyomata. Obstet Gynecol 2006;107(2 Pt 1):376–382. DOI: 10.1097/01.AOG.0000196806.25897.7c.
  8. Michels KA, Velez Edwards DR, Baird DD, et al. Uterine leiomyomata and cesarean birth risk: A prospective cohort with standardized imaging. Ann Epidemiol 2014;24(2):122–126. DOI: 10.1016/j.annepidem.2013.10.017.
  9. Martin J, Ulrich ND, Duplantis S, et al. Obstetrical outcomes of ultrasound identified uterine fibroids in pregnancy. Am J Perinatol 2016;33(12):1218–1222. DOI: 10.1055/s-0036-1593389.
  10. Knight JC, Elliott JO, Amburgey OL. Effect of maternal retroplacental leiomyomas on fetal growth. J Obstet Gynaecol Can 2016;38(12): 1100–1104. DOI: 10.1016/j.jogc.2016.08.012.
  11. Lam SJ, Best S, Kumar S. The impact of fibroid characteristics on pregnancy outcome. Am J Obstet Gynecol 2014;211(4):395.e1–e5. DOI: 10.1016/j.ajog.2014.03.066.
  12. Sei K, Masui K, Sasa H, et al. Size of uterine leiomyoma is a predictor for massive haemorrhage during caesarean delivery. Eur J Obstet Gynecol Reprod Biol 2018;223(4):60–63. DOI: 10.1016/j.ejogrb.2018.02.014.
  13. Opçu HO, İskender CT, Timur H, et al. Outcomes after cesarean myomectomy versus cesarean alone among pregnant women with uterine leiomyomas. Int J Gynaecol Obstet 2015;130(3):244–246. DOI: 10.1016/j.ijgo.2015.03.035.
  14. Benson CB, Chow JS, Chang-Lee W, et al. Outcome of pregnancies in women with uterine leiomyomas identified by sonography in the first trimester. J Clin Ultrasound 2001;29(5):261–264. DOI: 10.1002/jcu.1031.
  15. Chen YH, Lin HC, Chen SF, et al. Increased risk of preterm births among women with uterine leiomyoma: A nationwide population-based study. Hum Reprod 2009;24(12):3049–3056. DOI: 10.1093/humrep/dep320.
  16. Zhao R, Wang X, Zou L, et al. Adverse obstetric outcomes in pregnant women with uterine fibroids in China: A multicenter survey involving 112,403 deliveries. PLoS One 2017;12(11):e0187821. DOI: 10.1371/journal.pone.0187821.
  17. Ezzedine D, Norwitz ER. Are women with uterine fibroids at increased risk for adverse pregnancy outcome? Clin Obstet Gynecol 2016;59(1):119–127. DOI: 10.1097/GRF.0000000000000169.
  18. Stout MJ, Odibo AO, Graseck AS, et al. Leiomyomas at routine second-trimester ultrasound examination and adverse obstetric outcomes. Obstet Gynecol 2010;116(5):1056–1063. DOI: 10.1097/AOG.0b013e3181f7496d.
  19. Keriakos R, Maher M. Management of cervical fibroid during the reproductive period. Case Rep Obstet Gynecol 2013;2013:984030. DOI: 10.1155/2013/984030.
  20. Shavell VI, Thakur M, Sawant A, et al. Adverse obstetric outcomes associated with sonographically identified large uterine fibroids. Fertil Steril 2012;97(1):107–110. DOI: 10.1016/j.fertnstert.2011.10.009.
  21. Levast F, Legendre G, Bouet PE, et al. Prise en charge des myomes utérins durant la grossesse [Management of uterine myomas during pregnancy]. Gynecol Obstet Fertil 2016;44(6):350–354. French. DOI: 10.1016/j.gyobfe.2016.04.007.
  22. Barinov SV, Tirskaya YI, Lazareva OV, et al. Pregnancy outcomes in women with large uterine fibroids. J Matern Fetal Neonatal Med 2022;35(25):5369–5374. DOI: 10.1080/14767058.2021.1879044.
  23. Goyal M, Dawood AS, Elbohoty SB, et al. Cesarean myomectomy in the last ten years; A true shift from contraindication to indication: A systematic review and meta-analysis. Eur J Obstet Gynecol Reprod Biol 2021;256:145–157. DOI: 10.1016/j.ejogrb.2020.11.008.
  24. Zhao R, Wang X, Zou L, et al. Outcomes of myomectomy at the time of cesarean section among pregnant women with uterine fibroids: A retrospective cohort study. Biomed Res Int 2019;2019:7576934. DOI: 10.1155/2019/7576934.
  25. Kwon JY, Byun JH, Shin I, et al. Risk factors for intraoperative hemorrhage during cesarean myomectomy. Taiwan J Obstet Gynecol 2021;60(1):41–44. DOI: 10.1016/j.tjog.2020.11.007.
  26. Chu FC, Shaw SW, Lo LM, et al. Association between maternal anemia at admission for delivery and adverse perinatal outcomes. J Chin Med Assoc 2020;83(4):402–407. DOI: 10.1097/JCMA.0000000000000215.
  27. Liu CH, Chang WH, Yeh CC, et al. Simultaneous myomectomy during cesarean section. Taiwan J Obstet Gynecol 2021;60(3):397–398. DOI: 10.1016/j.tjog.2021.03.002.
  28. Dubuisson J, Ramyead L, Streuli I. The role of preventive uterine artery occlusion during laparoscopic myomectomy: A review of the literature. Arch Gynecol Obstet 2015;291(4):737–743. DOI: 10.1007/s00404-014-3546-4.
  29. Carlo Bulletti C, De D Ziegler, Polli V, et al. The role of leiomyomas in infertility. The Journal of the American Association of Gynecologic Laparoscopists 1999;6(4):441–445. DOI:
  30. Sentilhes L, Sergent F, Verspyck E, et al. Laparoscopic myomectomy during pregnancy leading in septic necrosis of the myometrium. BJOG 2003;110(9):876–878. DOI: 10.1111/j.1471-0528.2003.03045.x.
  31. Saccardi C, Visentin S, Noventa M, et al. Uncertainties about laparoscopic myomectomy during pregnancy: A lack of evidence or an inherited misconception? A critical literature review starting from a peculiar case. Minim Invasive Ther Allied Technol 2015;24(4):189–194. DOI: 10.3109/13645706.2014.987678.
  32. Jhalta P, Negi SG, Sharma V. Successful myomectomy in early pregnancy for a large asymptomatic uterine myoma: Case report. Pan Afr Med J 2016;24:228. DOI: 10.11604/pamj.2016.24.228.9890.
  33. Yoshino O, Hayashi T, Osuga Y, et al. Decreased pregnancy rate is linked to abnormal uterine peristalsis caused by intramural fibroids. Hum Reprod 2010;25(10):2475–2479. DOI: 10.1093/humrep/deq222.
  34. Milazzo GN, Catalano A, Badia V, et al. Myoma and myomectomy: Poor evidence concern in pregnancy. J Obstet Gynaecol Res 2017;43(12):1789–1804. DOI: 10.1111/jog.13437.
  35. Fukuda M, Tanaka T, Kamada M, et al. Comparison of the perinatal outcomes after laparoscopic myomectomy versus abdominal myomectomy. Gynecol Obstet Invest 2013;76(4):203–208. DOI: 10.1159/000355098.
PDF Share
PDF Share

© Jaypee Brothers Medical Publishers (P) LTD.