Fibroids During Pregnancy: Effects on Pregnancy and Neonatal Outcomes

To determine the effects of fibroids on pregnancy and neonatal parameters.

A total of 12,855 consecutive pregnant women admitted to a tertiary care university hospital between January 2002 and December 2009 were retrospectively reviewed. Of those, 267 patients with fibroids and 267 age- and parity-matched controls were included. The Clavien-Dindo classification was used to grade postoperative complications.

Mean gestational age at delivery (p<0.001) and mean neonatal birthweight (p=0.034) were significantly different between the 2 groups. We recorded a higher rate of pain-related hospitalization in the large fibroid group (38.2% and 7.8%, p <0.001). Myomectomy was performed in 124 of 267 patients during cesarean section (C/S). The myomectomy group was associated with lower postoperative hemoglobin levels (p=0.01) and higher need for transfusion (p=0.009). When postpartum hemoglobin levels of the control group and fibroid group without myomectomy were compared, hemoglobin levels were higher in favor of the control group (p = 0.009).

Beyond lower gestational age and mean birthweight, perinatal complications did not increase with fibroids during pregnancy. Performing myomectomy increases the need for transfusion (Grade 2) without an increase in the risk of hysterectomy (Grade 3) and other life-threatening complications (Grade 4-5). Leaving fibroids in situ during C/S did not prevent a fall in post-partum hemoglobin levels.