Assessment of pregnancy outcomes with uterine leiomyomas larger than 10 cm; antepartum and postpartum complications.

Fig. 1. A 37-year-old patient underwent hysterectomy in the postpartum period because of impaired drainage of the uterus caused by a submucosal component of an infected leiomyoma. 74 75 76 77 78 79 80 81 82 83 84 85 86 87 88 89 90 91 92 93 94 95 96 97 98 99 100 101 102 103 104 105 106 107 108 109 110 111 U N C O R R E We have found that the increased number of premature deliveries and cesarean deliveries, as well as the increase in postpartum bleeding and infections such as endometritis, may be caused by large uterine myomas. Sonograms in patients with fibroids were reviewed between 2007 and 2009 in the Department of Obstetrics and Gynecology at Ege University to determine the number of fibroids, their sizes, their locations, and relationship with the placenta. Cesarean ratio, preterm loss of pregnancy, and the incidence of postpartum complications were also evaluated. Our study population consisted of 21 women with uterine leiomyomas larger than 10 cm (12 subserous, 8 intramural, and 1 submucosal). The median age of patients was 34.6 years. Among patients with fibroids, 2 of the cases resulted from assisted conception. Tocolytic treatment was required in 47% of the pregnancies. Retroplacental localization of myomas was explored in 6 cases, and preterm delivery occurred in 2 of them. Cesarean section had to be performed because of preterm membrane rupture (9%) and malposition (29%) in 8 patients. Only 5 patients attempted vaginal delivery (23%), although in recent studies, median vaginal delivery rates range from 49% to 61%. Multiple myomas were identified in 66% of pregnant women and were associated with increased risk of malposition, breech presentation, and severe postpartum bleeding when compared to published articles including women with anatomically normal uteruses. Myomectomy at the time of cesarean delivery was performed in 33% of patients only for pedinculated subserosal myomas. In 1 case, postpartum fever occurred 2 weeks subsequent to cesarean delivery. The patient did not respond to intravenous antibiotic therapy and intracavity fluid collection, which was explored