title: Number and size of uterine fibroids and obstetric outcomes.
abstract: OBJECTIVE
  Estimating the impact of sonographically identified multiple or large (≥5 cm in diameter) fibroids on obstetric outcomes.
  
  
  METHODS
  Retrospective cohort study of 219 women with uterine fibroids (identified on a routine second-trimester ultrasound survey over a 3-year period, 2010-2012) and their age-matched controls. Inclusion criteria were singleton pregnancy, delivery at >24 weeks of gestation and no pathological conditions (chronic hypertension, gestational diabetes or pre-existing diabetes mellitus, uterine anomalies or fetal malformations).
  
  
  RESULTS
  Compared to women with no fibroids, women with multiple fibroids (n = 34) had a significantly higher rate of preterm birth (29.4% versus 5%, p < 0.001), cesarean section (73.5% versus 37%, p < 0.001) and breech presentation (11.8% versus 2.7%, p = 0.04). Women with large fibroids (n = 48) had a higher rate of preterm birth (16.7% versus 5%, p = 0.01) and pPROM (10.4% versus 0.5%, p < 0.001). By multivariate analysis, only multiple fibroids and previous preterm birth showed an independent significant association with preterm birth (OR = 7.37, 95% CI 2.50-21.68 and OR = 13.01, 95% CI 3.56-47.52, respectively).
  
  
  CONCLUSIONS
  Women with uterine fibroids are at an increased risk of obstetric complications. In particular, multiple rather than large fibroids are associated with a significantly increased risk of preterm birth and cesarean delivery while large fibroids are associated with a higher risk of pPROM. No correlation with IUGR, placenta previa or placental abruption was found.
authors.affiliation: Woman's Health Sciences Department, Gynaecologic Section, Polytechnic University of Marche , Ancona , Italy.
authors.forename: Andrea
authors.initials: A
authors.lastname: Ciavattini
authors.forename: Nicolò
authors.initials: N
authors.lastname: Clemente
authors.forename: Giovanni
authors.initials: G
authors.lastname: Delli Carpini
authors.forename: Jacopo
authors.initials: J
authors.lastname: Di Giuseppe
authors.forename: Stefano Raffaele
authors.initials: SR
authors.lastname: Giannubilo
authors.forename: Andrea Luigi
authors.initials: AL
authors.lastname: Tranquilli
mesh_terms: D000328:Adult; D016022:Case-Control Studies; D002585:Cesarean Section / Q000706:statistics & numerical data; D005260:Female; D005322:Premature Rupture of Fetal Membranes / Q000453:epidemiology; D006801:Humans; D007231:Infant, Newborn; D007889:Leiomyoma / Q000000981:diagnostic imaging / Q000453:epidemiology* / Q000473:pathology*; D011247:Pregnancy; D011252:Pregnancy Complications, Neoplastic / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000473:pathology; D011256:Pregnancy Outcome / Q000453:epidemiology*; D047928:Premature Birth / Q000453:epidemiology; D012189:Retrospective Studies; D047368:Tumor Burden; D016216:Ultrasonography, Prenatal; D014594:Uterine Neoplasms / Q000000981:diagnostic imaging / Q000453:epidemiology* / Q000473:pathology*
keywords: Leiomyoma; obstetric outcomes; pregnancy; premature birth; ultrasonography