Fibroids and reproductive outcomes: a systematic literature review from conception to delivery.
We examined the published relationship between uterine fibroids and reproductive outcomes. Submucosal fibroids had the strongest association with lower ongoing pregnancy rates, odds ratio, 0.5; 95% confidence interval, 0.3-0.8, primarily through decreased implantation. Cumulative pregnancy rates appeared slightly lower in patients with intramural fibroids 36.9% vs 41.1%, which may reflect biases in the literature; however, patients with intramural fibroids also experienced more miscarriages, 20.4% vs 12.9%. Adverse obstetric outcomes are rare and may reflect age or other differences in fibroid populations. Increased risk of malpresentation (odds ratio, 2.9; 2.6-3.2), cesarean (odds ratio, 3.7; 3.5-3.9), and preterm delivery (odds ratio, 1.5; 1.3-1.7) are reported; however, the incidence of labor dystocia was low (7.5%). There was no conclusive evidence that intramural or subserosal fibroids adversely affect fecundity. More prospective, controlled trials are needed to assess the effects of myomectomy. Good maternal and neonatal outcomes are expected in pregnancies with uterine fibroids.
Klatsky
Peter C
PC
Department of Obstetrics, Gynecology and Reproductive Science, Mount Sinai School of Medicine New York, NY, USA.
Tran
Nam D
ND
Caughey
Aaron B
AB
Fujimoto
Victor Y
VY
D000022:Abortion, Spontaneous / Q000209:etiology*; D002585:Cesarean Section; D004420:Dystocia / Q000209:etiology*; D005260:Female; D005298:Fertility; D006801:Humans; D007247:Infertility, Female / Q000209:etiology*; D007746:Labor Presentation; D007889:Leiomyoma / Q000150:complications*; D011247:Pregnancy; D011252:Pregnancy Complications, Neoplastic; D011256:Pregnancy Outcome; D018873:Pregnancy Rate; D014594:Uterine Neoplasms / Q000150:complications*