European Journal of Cardiovascular Medicine

Uterine fibroid or Leiomyoma are tumours that arise from smooth muscle of the uterus, which are benign in nature. These are the most common neoplasm affecting women and are diagnosed in up to 70% of women during their lifetime, approximately 30% of which will present with symptoms ⁽¹⁾.

The common symptoms include heavy menstrual bleeding, anaemia and fatigue, non-cyclic pain, dysmennorea, abdominal protuberance, painful intercourse, pelvic pressure, bladder or bowel dysfunction. Fibroids are also associated with reproductive problems, including impaired fertility, pregnancy complications and loss, acute abdomen in pregnancy, cephalopelvic disproportion, APH, preterm labor, malpresentation, PPH, dysfunctional labor, IUGR, and retained products of placenta ^(2,3).

This disease has a great impact on health care delivery and costs worldwide. Despite their growing prevalence, the relation between fibroid and adverse pregnancy outcomes are not yet clearly understood. Therefore, analysis of such data will make practitioners wiser when dealing with fibroids in pregnancy.

Aims/ Objectives of study

The aim of the study is to identify fetomaternal outcomes in patients with fibroid in pregnancy and to find out the prevalence of fibroid complicating pregnancy over 1 year at SMGS Jammu.

This was a retrospective study of antenatal cases who were admitted with fibroid complicating pregnancies in the  labour room, Department of obstetrics and gynecology, SMGS Hospital Jammu over a period of 1 year from July 2022 to June 2023, after obtaining ethical clearance from institutional ethical committee.

A detailed history was noted. All these cases were scrutinized for demographic data, parity, gestational age, etc. Obstetric complications like caesarean delivery, malpresentation, preterm delivery, placenta previa, abruptio placentae, premature rupture of membranes, postpartum haemorrhage and need for blood transfusion were studied.

Fetal complications like incidence of IUGR, malpresentations, low birth weight, low APGAR score, NICU admission were also recorded.

Source of data were files from MRD section, admission register, OT registers, delivery registers, NICU registers and census papers.

The data thus collected, was analyzed to estimate the incidence of fibroid complicating pregnancy, fetomaternal outcomes and complications in these patients.

Inclusion criteria

• All pregnancies complicated by fibroid were included.

Exclusion criteria

Patients with multiple pregnancy were excluded from the study. 

There were 18682 deliveries during this period, out of which 61 females had pregnancy complicated with fibroid who were included in the study. The prevalence was estimated to be 0.3%.

The mean age of the participants was 29.1 +- 4.7 yrs. Most of the cases were in age group 26-30 yrs (n= 27, 44.3%), followed by 18-25 years (n= 17, 27.9%) as given in figure 1.

Figure 1: Age Distribution

Most of the patients were primigravia in our study, followed by gravida 3 and gravida 2 (Figure 2)

Figure 2: Gravida status

Period of gestation (POG) at termination of pregnancy was 37-40 weeks in 50.8% of the cases, the mean POG was 36 week 1 day +- 3 weeks. Distribution of cases according to period of gestation is given in Table 1.

Table 1: Gestational age at termination of pregnancy

25 patients had vaginal delivery constituting 40% of deliveries, 3 patients had assisted breech vaginal delivery and most patients (34, 55.8%) underwent LSCS as given in table 2.

Table 2: Mode of delivery

LSCS were performed for various indications as tabulated in Table 3, 29.4% patients had LSCS in view of Previous LSCS with other factors, 14.7% patients had non progression of labor (NPOL). Fetal distress in 11.8% and malpresentation was seen in 11.8% of the females that underwent LSCS.

Table 3: Indications for LSCS

Preterm labour was most common complication seen in 10 ( 16.4%) cases, followed by preterm premature rupture of membranes (PPROM) in 9 (14.7%) cases. Other complications like need for blood transfusion (13.1%), IUGR (11.5%) and malpresentation (11.5%) were also seen as present in table 4.

Table 4: Maternal complications

There were 59 live births, among the 61 cases. There were 2 patients with intrauterine death, one was at 19 weeks who underwent hysterotomy due to prior 2 caesareans and other was IUD at 35 weeks who delivered vaginally. 19 neonates comprising 31.2% of the total births had birth weight less than 2.5 kg. 4 neonates were severely depressed at birth (6.8% of live births ) with APGAR score less than 3 at 1 min. at 5 min there were 2 neonates (3.4% of live births )  with APGAR less than 3, 7 neonates (11.8%) required NICU admission at birth  (Table 5).

Table 5: Neonatal outcomes

In our study, the prevalence of fibroid complicating pregnancy was 0.3% over 1 year. Singh LR et al., also found the prevalence of fibroid with pregnancy to be 0.3% in their study (4). Likewise, Bhat P et al., estimated it to be 0.5% in their research ⁽⁵⁾.

The mean age of the participants was 29.1 +- 4.7 years, 44.3% of them belonged to age group 26-30 years though the risk of fibroid is known to increase with age, the second and third decade of life show its rising incidence. Other studies by Choudhary A et al., and Singh LR et al., found out the age group of most women to be 26-30 years (42.7%) and 30-40 years (73.9%)respectively ^(6,4).

Multiparity is a protective factor for occurrence of fibroids. In our study we found most cases to be primigravidas (54.1%), this is consistent with studies by Pandit U et al., and Tîrnovanu SD et al., who had 52% and 64.9% primigravida respectively ^(7,8).

55.8% of cases underwent LSCS in our study which was more than Vaginal deliveries (40%), this is similar to Posh S et al., who had 69.2% patients that had LSCS in their study ⁽⁹⁾. The most frequent indication in 10 (29.4%) cases was for previous LSCS which was comparable to 28% as observed by Sharma V et al., ⁽¹⁰⁾

Preterm labor was most common maternal complication seen in 16.4% of women, Singh S et al., observed this complication to be present in 20% women with multiple fibroids ⁽³⁾.

Malpresentations were seen in 7 (11.5%) and PPH in 6 (9.8%) pregnancies similar to study by Sandhyarani B et al., who had 11.1% of patients with malpresentation and 7.4% with PPH in their study ⁽¹¹⁾.  IUGR was present in 7 (11.5%) of pregnancies in our study, similarly Posh S et al., mentioned IUGR in 7.7% of their subjects ⁽⁹⁾. In our study, 5 cases (8.1%) developed placental abruption in labour, Mushtaq R et al., found out its incidence to be 5.2% among their participants ⁽¹²⁾.

Low birth weight was seen in 31% of neonates in our study, which is similar to Singh S et al., with 32.1% of neonates being low birth weight ⁽³⁾.  Apgar score at 1 min less than 7 was seen in 22% of patients, which is similar to Vincent A et al., with 20.8% of neonates with Apgar <7 ⁽¹³⁾. 88.1% of neonates in our study subsequently had Apgar score >7 at 5 mins, likewise 89.1% neonates had Apgar score >7 by 5 mins in the study carried out by Choudhary A et al., ⁽⁶⁾. 7 babies (11.8%) required NICU admission at birth. Studies by Posh S et al., and Singh LR et al., have observed NICU admission rates to be 7.7% and 4.6 % respectively ^(9,4).

Pregnancy with fibroids are considered as high risk pregnancy. They are complicated with preterm labour, PPROM, malpresentation, abruption, PPH, IUGR, low Apgar score, increased NICU admissions and increased rate of caesarean delivery. Pregnancy complicated with fibroid warrants multiple follow up and assessment during antenatal, intrapartum and postpartum period to improve the feto-maternal outcomes.

Funding: No funding sources

Conflict of interest: None declared

Ethical approval: The study was approved by the Institutional Ethics Committee

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