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#Grand Rounds

Are Fibroids Associated with an Increased Risk for Preterm Birth?

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BACKGROUND AND PURPOSE: 

  • Girault et al. (Am J Obstet Gynecol, 2018) assessed 
    • The association between uterine leiomyomas in pregnancy and preterm birth 
    • Whether any association remains following myomectomy 

METHODS: 

  • Retrospective cohort study  
    • Women with singleton pregnancies delivering >22 weeks  
    • Women with a leiomyomatous uterus were compared to women with no myomas 
  • Leiomyomatous uterus group consisted of either  
    • No history of myomectomy: ≥1 fibroid measuring ≥20 mm or multiple leiomyomas during pregnancy regardless of size | Seen on at least 1 obstetric ultrasound  | No history of myomectomy or 
    • History of myomectomy: Removal of ≥1 fibroid measuring ≥20 mm or multiple leiomyomas regardless of size, with or without persistent fibroids   
  • Primary outcome: Preterm birth <37 weeks whatever the cause 
  • Secondary outcomes  
    • Spontaneous preterm birth | Induced preterm birth 
  • Characteristics possibly related to preterm birth were collected and assessed for confounding  

RESULTS: 

  • 19,866 women were included in the study 
  • 301 (1.5%) had a leiomyomatous uterus  
    • 154 without surgery | 147 with surgery  
  • Leiomyomatous uterus was significantly associated with rate of preterm birth 
    • 12.0% in the leiomyomatous uterus group 
    • 8.4% in the nonleiomyomatous uterus group 
    • Adjusted odds ratio (OR) 2.5 (95% CI, 1.7–3.7) 
  • Both surgical and non-surgical cases were significantly associated with preterm birth   
    • Without myomectomy: aOR 2.7 (95% CI, 1.6–4.6) 
    • With myomectomy: adjusted OR 2.3 (95% confidence interval, 1.3–3.9) 

CONCLUSION: 

  • There is a 2.5-fold increased risk for preterm birth for women with fibroids  
  • This association  
    • Persists even after myomectomy 
    • Regardless of spontaneous or induced  
  • Possible mechanisms 
    • Women can still have fibroids present after surgery  
    • Surgery may alter myometrial muscle fibers and/or result in compromised dicidua/cellular hormonal function   
  • Authors acknowledge limitations of their study, including the chance that women in the non-exposed group may have had fibroids, leading to inaccurate associations  
    • However, women who are at risk for preterm birth may often undergo multiple ultrasounds  

Learn more – Primary Sources: 

Leiomyomatous uterus and preterm birth: an exposed/unexposed monocentric cohort study

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Related ObG Topics:

Are Fibroids Associated with Miscarriage?
What is the Risk of Myomectomy at the Time of Cesarean Section?
From Genetics to Soybeans: What are the Risk Factors for Uterine Fibroids?
High-Intensity Ultrasound for Fibroids – What are the Pregnancy Outcomes?

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