Advertisement

Updates in Surgery

, Volume 65, Issue 3, pp 179–182 | Cite as

Management of uterine leiomyomas in pregnancy: review of literature

  • Salvatore Giovanni Vitale
  • Alessandro Tropea
  • Diego Rossetti
  • Marco Carnelli
  • Antonio Cianci
Review Article

Abstract

The incidence of uterine myomas in pregnancy is estimated from 0.1 to 3.9 %. Although a lot of women with uterine fibroids bring the pregnancy without adverse events, data provided in the literature suggest that uterine fibromyomas are associated with several complications. The most important clinic question concerns the impact of myoma on pregnancy and, in some cases, the possibility of a surgical treatment that guarantees a good security for the pregnancy course and the conservation of reproductive capacity. Electronic search of Pubmed between 1993 and 2011, using specific keywords. Management of leiomyomas in pregnancy is conservative and limited, when it is necessary, to medical therapy. The main conditions that induce inevitably the surgical procedure are the torsion of pedunculated fibroid or rare cases of necrosis and resultant inflammatory peritoneal reaction. Laparoscopy technique has several advantages in comparison to previous techniques such as best postoperative course with reduction of pain, fast recovery, less hospitalization and, absence of large and unaesthetic scars. The importance of maternal and fetal welfare thus requires a careful evaluation of several factors that, varying from case to case, lead the authors to choose the most appropriate management.

Keywords

Myoma Pregnancy Ultrasonographic monitoring Laparotomic myomectomy Laparoscopic myomectomy 

Notes

Conflict fo interest

None.

References

  1. 1.
    Wallach EE, Vlahos NF (2004) Uterine myomas: an overview of development, clinical features, and management. Obstet Gynecol 104(2):393–406PubMedCrossRefGoogle Scholar
  2. 2.
    Sunkara SK, Khairy M, El-Toukhy T, Khalaf Y, Coomarasamy A (2010) The effect of intramural fibroids without uterine cavity involvement on the outcome of IVF treatment: a systematic review and meta-analysis. Hum Reprod 25(2):418–429PubMedCrossRefGoogle Scholar
  3. 3.
    Lee HJ, Norwitz ER, Shaw J (2010) Contemporary Management of Fibroids in Pregnancy. Rev Obstet Gynecol 3(1):20–27PubMedGoogle Scholar
  4. 4.
    Parker WH (2007) Etiology, symptomatology, and diagnosis of uterine myomas. Fertil Steril 87(4):725–736PubMedCrossRefGoogle Scholar
  5. 5.
    Day Baird D, Dunson DB, Hill MC, Cousins D, Schectman JM (2003) High cumulative incidence of uterine leiomyoma in black and white woman: ultrasound evidence. Am J Obstet Gynecol 188(1):100–107CrossRefGoogle Scholar
  6. 6.
    Baloniak B, Slomko Z, Malewski Z, Drews K (2002) The incidence of uterine leiomyomas in pregnancy and their influence upon its course. Ginekol Pl 73(4):260–265Google Scholar
  7. 7.
    De Vivo A, Mancuso A, Giacobbe A, Savasta LM, De Dominici R, Dugo N, Vaiarelli A (2011) Uterine myomas during pregnancy: a longitudinal sonographic study. Ultrasound Obstet Gynecol 37(3):361–365PubMedCrossRefGoogle Scholar
  8. 8.
    Benson CB, Chow JS, Chang-Lee W, Hill JA 3rd, Doubilet PM (2001) Outcame of pregnancies in women with uterine leiomyomas identified by sonography in the first trimester. J Clin Ultrasound 29(5):261–264PubMedCrossRefGoogle Scholar
  9. 9.
    Lolis DE, Kalantaridou SN, Makrydimas G, Sotiriadis A, Navrozoglou I, Zikopoulos K, Paraskevaidis EA (2003) Successful myomectomy during pregnancy. Hum Reprod 18(8):1699–1702PubMedCrossRefGoogle Scholar
  10. 10.
    Coronado GD, Marshall LM, Schwartz AM (2000) Complications in pregnancy, labor and delivery with uterine leiomyomas: a population based-study. Obstet Gynecol 95(5):764–769PubMedCrossRefGoogle Scholar
  11. 11.
    Chuang J, Tsai HW, Hwang JL (2001) Fetal compression syndrome caused by myoma in pregnancy: a case report. Acta Obstet Gynecol Scand 80(5):472–473PubMedCrossRefGoogle Scholar
  12. 12.
    Lee HJ, Norwitz ER, Shaw J (2010) Contemporary Management of Fibroids in Pregnancy. Rev Obstet Gynecol 3(1):20–27PubMedGoogle Scholar
  13. 13.
    Phelan JP (1995) Myomas and Pregnancy. Obstet Gynecol Clin North Am 22(4):801–805PubMedGoogle Scholar
  14. 14.
    Exacoustòs C, Rosati P (1993) Ultrasound diagnosis of uterine myomas and complications in pregnancy. Obstet Gynecol 82(1):97–101PubMedGoogle Scholar
  15. 15.
    Leach K, Khatain L, Tocce K (2011) First trimester myomectomy as an alternative to termination of pregnancy in a woman with a symptomatic uterine leiomyoma: a case report. J Med Case Rep 5(1):571PubMedCrossRefGoogle Scholar
  16. 16.
    Cagnacci A, Pirillo D, Malmusi S, Arangino S, Alessandrini C, Volpe A (2003) Early outcome of myomectomy by laparotomy, minilaparotomy and laparoscopically assisted minilaparotomy. A randomized prospective study. Hum Reprod 18(12):2590–2594CrossRefGoogle Scholar
  17. 17.
    Takeuchi H, Kuwatsuru R (2003) The indications, surgical techniques, and limitations of laparoscopic myomectomy. JSLS 7(2):89–95PubMedGoogle Scholar
  18. 18.
    Sizzi O, Rossetti A, Malzoni M, Minelli L, La Grotta F, Soranna L, Panunzi S, Spagnolo R, Imperato F, Landi S, Fiaccamento A, Stola E (2007) Italian multicenter study on complications of laparoscopic myomectomy. J Minim Invasive Gynecol 14(4):453–462PubMedCrossRefGoogle Scholar
  19. 19.
    Grande N, Catalano GF, Ferrari S, Marana R (2005) Spontaneous uterine rupture at 27 weeks of pregnancy after laparoscopic myomectomy. J Minim Invasive Gynecol 12(4):301PubMedCrossRefGoogle Scholar
  20. 20.
    Malzoni M, Tinelli R, Cosentino F, Iuzzolino D, Surico D, Reich H (2010) Laparoscopy versus minilaparotomy in women with symptomatic uterine myomas: short-term and fertility results. Fertil Steril 93(7):2368–2373PubMedCrossRefGoogle Scholar
  21. 21.
    Yellamareddygari S, Chakrabarti M, Ravuri S, Ahluwalia A (2010) Leaving fibroids at cesarean section, is it safe? Gynecol Surg 7(2):173–175CrossRefGoogle Scholar

Copyright information

© Springer-Verlag Italia 2013

Authors and Affiliations

  • Salvatore Giovanni Vitale
    • 1
    • 4
  • Alessandro Tropea
    • 2
  • Diego Rossetti
    • 3
  • Marco Carnelli
    • 3
  • Antonio Cianci
    • 1
  1. 1.Gynecology and Obstetrics Unit, Department of Obstetrics and Gynecology and Radiological SciencesUniversity of CataniaCataniaItaly
  2. 2.Department of SurgeryUniversity of CataniaCataniaItaly
  3. 3.Division of Gynecology and ObstetricsOspedali Riuniti di Bergamo, Milano Bicocca UniversityBergamoItaly
  4. 4.CataniaItaly

Personalised recommendations