title: Adverse obstetric outcomes associated with sonographically identified large uterine fibroids.
abstract: OBJECTIVE
  To determine the impact of sonographically identified large uterine fibroids (>5 cm in diameter) on obstetric outcomes.
  
  
  METHODS
  Retrospective cohort study.
  
  
  METHODS
  University teaching hospital.
  
  
  METHODS
  Women with singleton gestations (n = 95) noted to have uterine fibroids on obstetric ultrasonography from September 2009 through April 2010 and age-matched controls (n = 95).
  
  
  METHODS
  None.
  
  
  METHODS
  Obstetric outcomes including short cervix, preterm premature rupture of membranes, and preterm delivery.
  
  
  RESULTS
  Compared to women with no fibroids or small fibroids (≤5 cm), women with large fibroids (>5 cm) delivered at a significantly earlier gestational age (38.6 vs. 38.4 vs. 36.5 weeks). Short cervix, preterm premature rupture of membranes, and preterm delivery were also significantly more frequent in the large fibroid group, and were associated with number of fibroids >5 cm in diameter. Blood loss at delivery was significantly higher in the large fibroid group (486.8 vs. 535.6 vs. 645.1 mL), as was need for postpartum blood transfusion (1.1 vs. 0.0 vs. 12.2%).
  
  
  CONCLUSIONS
  Women with large uterine fibroids in pregnancy are at significantly increased risk for delivery at an earlier gestational age compared to women with small or no fibroids, as well as obstetric complications including excess blood loss and increased frequency of postpartum blood transfusion.
authors.affiliation: Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Wayne State University, Detroit, Michigan, USA. vshavell@med.wayne.edu
authors.forename: Valerie I
authors.initials: VI
authors.lastname: Shavell
authors.forename: Mili
authors.initials: M
authors.lastname: Thakur
authors.forename: Anjali
authors.initials: A
authors.lastname: Sawant
authors.forename: Michael L
authors.initials: ML
authors.lastname: Kruger
authors.forename: Theodore B
authors.initials: TB
authors.lastname: Jones
authors.forename: Manvinder
authors.initials: M
authors.lastname: Singh
authors.forename: Elizabeth E
authors.initials: EE
authors.lastname: Puscheck
authors.forename: Michael P
authors.initials: MP
authors.lastname: Diamond
mesh_terms: D000328:Adult; D001803:Blood Transfusion / Q000706:statistics & numerical data; D015331:Cohort Studies; D016208:Databases, Factual / Q000706:statistics & numerical data; D005260:Female; D005322:Premature Rupture of Fetal Membranes / Q000453:epidemiology; D006801:Humans; D007889:Leiomyoma / Q000000981:diagnostic imaging / Q000453:epidemiology*; D006473:Postpartum Hemorrhage / Q000453:epidemiology / Q000628:therapy; D011247:Pregnancy; D011252:Pregnancy Complications, Neoplastic / Q000000981:diagnostic imaging / Q000453:epidemiology*; D011256:Pregnancy Outcome / Q000453:epidemiology*; D047928:Premature Birth / Q000453:epidemiology; D012189:Retrospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index; D014463:Ultrasonography; D002581:Uterine Cervical Incompetence / Q000453:epidemiology; D014594:Uterine Neoplasms / Q000000981:diagnostic imaging / Q000453:epidemiology*