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Intrapartum Ultrasound in Myoma Patients Before the Labor and Delivery and Management

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Intrapartum Ultrasonography for Labor Management

Abstract

Myomas are the most common neoplasms of the female reproductive organs, causing significant health problems. Overall myoma incidence during pregnancy is expected to rise in the future, due to association of myoma formation and women’s age and global trend of delayed childbearing.

The data on myoma size changes throughout pregnancy were evaluated by many authors. Mostly of them found myoma shrinkage after delivery, probably due to uterine remodeling during puerperium, causing selective apoptosis of small tumors, even if data on modifications in myoma size during pregnancy are conflicting.

Only 10–40% of pregnants with myomas will have symptoms during pregnancy, while the others have uneventful pregnancies.

Imaging techniques are necessary for adequate myoma diagnosis, providing data on localization, number and size of myomas, presence of secondary changes, their relationship to the placenta, and differential diagnosis from other myometrial pathologies and uterine contractions.

Ultrasound is a safe, widely accessible, and inexpensive diagnostic tool. However, sensitivity of ultrasound is diminished in cases of enlarged uterus, either due to pregnancy or presence of multiple myomas. The best approach is combined transabdominal and transvaginal ultrasound, as myomas frequently can be multiple. Doppler findings and velocimetry indices are useful in evaluation of myoma vasculature and could predict its proliferative status. Although it is much a superior diagnostic tool, MRI is necessary in minority of pregnant patients. It provides additional information which are useful particularly in cases requiring surgical treatment during pregnancy or at the time of cesarean section (CS), which require precise evaluation of the myoma vasculature, in relation to the placental site and uterine cavity.

Myomas per se should not be considered as a contraindication for vaginal delivery, although they frequently represent an indication for CS, facing obstetricians with a more than a century old dilemma: whether to perform a myomectomy during cesarean delivery. During CS, myomectomy is, in some instances, necessary either for delivery of the fetus or for hysterotomy suturing. Although not strictly defined, both indications and contraindications for cesarean myomectomy (CM) have been suggested in previous literature reports. Despite CM represents a major surgery, thus possibly increasing risks of CS alone, it has numerous advantages for women undergoing it. Regardless of growing frequency of myomas in pregnancy, their management in women wishing pregnancy and particularly during labor and delivery is not straightforward.

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Authors and Affiliations

  1. Clinic for Gynecology and Obstetrics, Clinical Centre of Serbia, Belgrade, Serbia

    Radmila Sparić

  2. University of Belgrade, Belgrade, Serbia

    Radmila Sparić

  3. Department for Histopathology, Clinical Centre of Serbia, Belgrade, Serbia

    Radomir Stefanović

  4. Department of Planning, Analysing and Statistics, Primary Health Care Center Pančevo, Pančevo, Serbia

    Dragica Bukumirić

  5. Clinical Centre of Serbia, Belgrade, Serbia

    Vidan Topalović

  6. Clinic for Gynecology and Obstetrics “Narodni Front”, Belgrade, Serbia

    Sanja Novaković

  7. Department of Obstetrics and Gynecology, “Veris delli Ponti” Hospital, Scorrano, Lecce, Italy

    Andrea Tinelli

  8. International Translational Medicine and Biomodelling Research Group, Department of Applied Mathematics, Moscow Institute of Physics and Technology (State University), Dolgoprudny, Moscow, Russia

    Andrea Tinelli

  9. Laboratory of Human Physiology, Faculty of Biological and Medical Physics, Phystech BioMed School, Moscow Institute of Physics and Technology (State University), Moscow, Russia

    Andrea Tinelli

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  6. Andrea Tinelli
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Correspondence to Radmila Sparić .

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  1. Department of Obstetric and Gynecology, Santa Maria Hospital, GVM Care and Research, Bari, Italy

    Antonio Malvasi

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Sparić, R., Stefanović, R., Bukumirić, D., Topalović, V., Novaković, S., Tinelli, A. (2021). Intrapartum Ultrasound in Myoma Patients Before the Labor and Delivery and Management. In: Malvasi, A. (eds) Intrapartum Ultrasonography for Labor Management. Springer, Cham. https://doi.org/10.1007/978-3-030-57595-3_42

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  • DOI: https://doi.org/10.1007/978-3-030-57595-3_42

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