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Allen A, Schembri M, Parvataneni R, Waetjen LE, Varon S, Salamat-Saberi N, Tassone S, Williams N, Kho KA, Jacoby VL. Pregnancy Outcomes After Laparoscopic Radiofrequency Ablation of Uterine Leiomyomas Compared With Myomectomy. Obstet Gynecol 2024; 143:612-618. [PMID: 38422502 DOI: 10.1097/aog.0000000000005548] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Accepted: 01/18/2024] [Indexed: 03/02/2024]
Abstract
OBJECTIVE To compare pregnancy outcomes after laparoscopic radiofrequency ablation and myomectomy. METHODS The ULTRA (Uterine Leiomyoma Treatment With Radiofrequency Ablation) study is an ongoing multicenter prospective cohort study with longitudinal follow-up up to 5 years comparing outcomes of radiofrequency ablation with myomectomy in premenopausal women older than age 21 years with symptomatic uterine leiomyomas. Participants were queried every 6 months after surgery to assess the incidence of pregnancy and pregnancy outcomes. RESULTS Among 539 women enrolled in ULTRA, a total of 37 participants (mean age at first pregnancy 35.0±4.7 years) conceived 43 times as of March 2023 (22 radiofrequency ablation, 21 myomectomy). The average length of follow-up time after all procedures was 2.5±1.0 years. The baseline miscarriage rate in the study population was 33.3%. In participants who underwent radiofrequency ablation, 9 of 22 pregnancies (40.9%, 95% CI, 20.3-61.5%) ended in first-trimester miscarriage, 11 resulted in live births (50.0%, 95% CI, 29.1-70.9%), one resulted fetal death at 30 weeks of gestation, and one resulted in uterine rupture during miscarriage treatment with misoprostol 10 weeks after radiofrequency ablation. Among the live births in the radiofrequency ablation group, 45.5% were by vaginal delivery. In the myomectomy group, 9 of 21 pregnancies (42.9%, 95% CI, 21.7-64.0%) ended in first-trimester miscarriage and 12 resulted in live births (57.1%, 95% CI, 36.0-78.3%). There were no significant differences in the likelihood of live birth or miscarriage between the study groups. CONCLUSION Full-term pregnancy and vaginal delivery are achievable after radiofrequency ablation of leiomyomas. However, in this interim analysis, the miscarriage rate in both radiofrequency ablation and myomectomy groups was higher than expected for women in this age group. Long-term data collection in the ongoing ULTRA study aims to further understand pregnancy outcomes after radiofrequency ablation compared with myomectomy. CLINICAL TRIAL REGISTRATION ClinicalTrials.gov , NCT0210094.
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Affiliation(s)
- Antoinette Allen
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, the Departments of Obstetrics and Gynecology, University of California, Los Angeles, University of California, Davis, University of California, San Diego, and University of California, Irvine, and the University of California Fibroid Network, California; Tassone Advanced ObGyn, Round Rock, Texas; the Gynecological Institute of Chicago, Chicago, Illinois; and the Department of Obstetrics and Gynecology, University of Texas Southwestern Medical Center, Dallas, Texas
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Baseri N, Omidi AH, Latifian M, Mostafavi E, Khademvatan S, Omidifar N, Tabaei SJS, Jafari R, Zeinali S, Ghasemi A, Esmaeili S. Molecular examination for Coxiella burnetii and Brucella spp. infections in Iranian women experiencing spontaneous miscarriage. BMC Infect Dis 2024; 24:172. [PMID: 38326756 PMCID: PMC10848525 DOI: 10.1186/s12879-024-09041-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Accepted: 01/22/2024] [Indexed: 02/09/2024] Open
Abstract
BACKGROUND Spontaneous miscarriage, a leading health concern globally, often occurs due to various factors, including infections. Among these, Coxiella burnetii and Brucella spp. may have adverse effects on pregnancy outcomes. While previous research has established a link between infections and spontaneous miscarriage, our study aimed specifically to investigate the presence of these two pathogens in abortion samples from women who experienced spontaneous miscarriages in Iran. Our study can add to the existing knowledge by focusing on Iran, a region with a high prevalence of C. burnetii and Brucella spp. As a result, it could provide a better understanding and unique insights into the relationship of these pathogens with spontaneous miscarriages in endemic regions. METHODS From March 2021 to March 2022, a total of 728 abortion samples (including placenta and cotyledon) were collected from 409 women who had experienced spontaneous miscarriages in the provinces of Tehran, Fars, and West Azerbaijan in Iran. The specimens included 467 Formalin-Fixed Paraffin-Embedded (FFPE) and 261 fresh frozen samples. After DNA extraction from abortion samples, the quantitative real-time PCR (qPCR) assay targeted a specific fragment of the IS1111 and IS711 elements for molecular identification of C. burnetii and Brucella spp., respectively. Furthermore, the qPCR assay employing specific primers for different species was used to determine the species of Brucella. RESULTS Among the studied women, 1 out of 409 (0.24%) samples tested positive for Brucella spp., specifically Brucella melitensis. There were no positive specimens for C. burnetii. CONCLUSIONS Our study contributes to understanding the potential involvement of Brucella species in spontaneous infectious abortion within endemic regions. The identification of B. melitensis in this study highlights the need for further research in this area. However, while our results suggest a relatively low or zero identification of these pathogens in our sample population, this does not rule out the possibility of undetected infections. Therefore, it is critical to acknowledge the limitations of the molecular techniques used (qPCR), which may have potential limitations such as sensitivity and specificity. Moreover, because 64.15% of our samples were FFPE, the sensitivity of the qPCR test may be reduced. These raise concerns about the accuracy of the reported prevalence rates and the potential for false positives or negatives.
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Affiliation(s)
- Neda Baseri
- Department of Epidemiology and Biostatics, Research Centre for Emerging and Reemerging Infectious Diseases, Pasteur Institute of Iran, Tehran, Iran
- National Reference Laboratory for Plague, Tularemia and Q Fever, Research Centre for Emerging and Reemerging Infectious Diseases, Pasteur Institute of Iran, Akanlu, Hamadan, KabudarAhang, Iran
- Department of Bacteriology, Faculty of Medical Sciences, Tarbiat Modares University, Tehran, Iran
| | - Amir Hossein Omidi
- Department of Epidemiology and Biostatics, Research Centre for Emerging and Reemerging Infectious Diseases, Pasteur Institute of Iran, Tehran, Iran
- National Reference Laboratory for Plague, Tularemia and Q Fever, Research Centre for Emerging and Reemerging Infectious Diseases, Pasteur Institute of Iran, Akanlu, Hamadan, KabudarAhang, Iran
| | - Mina Latifian
- Department of Epidemiology and Biostatics, Research Centre for Emerging and Reemerging Infectious Diseases, Pasteur Institute of Iran, Tehran, Iran
- National Reference Laboratory for Plague, Tularemia and Q Fever, Research Centre for Emerging and Reemerging Infectious Diseases, Pasteur Institute of Iran, Akanlu, Hamadan, KabudarAhang, Iran
| | - Ehsan Mostafavi
- Department of Epidemiology and Biostatics, Research Centre for Emerging and Reemerging Infectious Diseases, Pasteur Institute of Iran, Tehran, Iran
- National Reference Laboratory for Plague, Tularemia and Q Fever, Research Centre for Emerging and Reemerging Infectious Diseases, Pasteur Institute of Iran, Akanlu, Hamadan, KabudarAhang, Iran
| | - Shahram Khademvatan
- Department of Medical Parasitology and Mycology, Urmia University of Medical Sciences, Urmia, Iran
- Cellular and Molecular Research Center, Cellular and Molecular Medicine Research Institute , Urmia University of Medical Sciences , Urmia , Iran
| | - Navid Omidifar
- Department of Pathology , School of Medicine, Shiraz University of Medical Sciences , Shiraz , Iran
| | - Seyyed Javad Seyyed Tabaei
- Department of Parasitology and Mycology, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Rasool Jafari
- Department of Medical Parasitology and Mycology, Urmia University of Medical Sciences, Urmia, Iran
| | - Shiva Zeinali
- Department of Medical Parasitology and Mycology, Urmia University of Medical Sciences, Urmia, Iran
| | - Ahmad Ghasemi
- National Reference Laboratory for Plague, Tularemia and Q Fever, Research Centre for Emerging and Reemerging Infectious Diseases, Pasteur Institute of Iran, Akanlu, Hamadan, KabudarAhang, Iran
- Department of Microbiology, Research Center of Reference Health Laboratories, Ministry of Health and Medical Education, Tehran, Iran
| | - Saber Esmaeili
- Department of Epidemiology and Biostatics, Research Centre for Emerging and Reemerging Infectious Diseases, Pasteur Institute of Iran, Tehran, Iran.
- National Reference Laboratory for Plague, Tularemia and Q Fever, Research Centre for Emerging and Reemerging Infectious Diseases, Pasteur Institute of Iran, Akanlu, Hamadan, KabudarAhang, Iran.
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Abstract
In this guideline, recurrent miscarriage has been defined as three or more first trimester miscarriages. However, clinicians are encouraged to use their clinical discretion to recommend extensive evaluation after two first trimester miscarriages, if there is a suspicion that the miscarriages are of pathological and not of sporadic nature. Women with recurrent miscarriage should be offered testing for acquired thrombophilia, particularly for lupus anticoagulant and anticardiolipin antibodies, prior to pregnancy. [Grade C] Women with second trimester miscarriage may be offered testing for Factor V Leiden, prothrombin gene mutation and protein S deficiency, ideally within a research context. [Grade C] Inherited thrombophilias have a weak association with recurrent miscarriage. Routine testing for protein C, antithrombin deficiency and methylenetetrahydrofolate reductase mutation is not recommended. [Grade C] Cytogenetic analysis should be offered on pregnancy tissue of the third and subsequent miscarriage(s) and in any second trimester miscarriage. [Grade D] Parental peripheral blood karyotyping should be offered for couples in whom testing of pregnancy tissue reports an unbalanced structural chromosomal abnormality [Grade D] or there is unsuccessful or no pregnancy tissue available for testing. [GPP] Women with recurrent miscarriage should be offered assessment for congenital uterine anomalies, ideally with 3D ultrasound. [Grade B] Women with recurrent miscarriage should be offered thyroid function tests and assessment for thyroid peroxidase (TPO) antibodies. [Grade C] Women with recurrent miscarriage should not be routinely offered immunological screening (such as HLA, cytokine and natural killer cell tests), infection screening or sperm DNA testing outside a research context. [Grade C] Women with recurrent miscarriage should be advised to maintain a BMI between 19 and 25 kg/m2 , smoking cessation, limit alcohol consumption and limit caffeine to less than 200 mg/day. [Grade D] For women diagnosed with antiphospholipid syndrome, aspirin and heparin should be offered from a positive test until at least 34 weeks of gestation, following discussion of potential benefits versus risks. [Grade B] Aspirin and/or heparin should not be given to women with unexplained recurrent miscarriage. [Grade B] There are currently insufficient data to support the routine use of PGT-A for couples with unexplained recurrent miscarriage, while the treatment may carry a significant cost and potential risk. [Grade C] Resection of a uterine septum should be considered for women with recurrent first or second trimester miscarriage, ideally within an appropriate audit or research context. [Grade C] Thyroxine supplementation is not routinely recommended for euthyroid women with TPO who have a history of miscarriage. [Grade A] Progestogen supplementation should be considered in women with recurrent miscarriage who present with bleeding in early pregnancy (for example 400 mg micronised vaginal progesterone twice daily at the time of bleeding until 16 weeks of gestation). [Grade B] Women with unexplained recurrent miscarriage should be offered supportive care, ideally in the setting of a dedicated recurrent miscarriage clinic. [Grade C].
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Hromadnikova I, Kotlabova K, Krofta L. First-Trimester Screening for Miscarriage or Stillbirth-Prediction Model Based on MicroRNA Biomarkers. Int J Mol Sci 2023; 24:10137. [PMID: 37373283 DOI: 10.3390/ijms241210137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Revised: 06/13/2023] [Accepted: 06/13/2023] [Indexed: 06/29/2023] Open
Abstract
We evaluated the potential of cardiovascular-disease-associated microRNAs to predict in the early stages of gestation (from 10 to 13 gestational weeks) the occurrence of a miscarriage or stillbirth. The gene expressions of 29 microRNAs were studied retrospectively in peripheral venous blood samples derived from singleton Caucasian pregnancies diagnosed with miscarriage (n = 77 cases; early onset, n = 43 cases; late onset, n = 34 cases) or stillbirth (n = 24 cases; early onset, n = 13 cases; late onset, n = 8 cases; term onset, n = 3 cases) and 80 selected gestational-age-matched controls (normal term pregnancies) using real-time RT-PCR. Altered expressions of nine microRNAs (upregulation of miR-1-3p, miR-16-5p, miR-17-5p, miR-26a-5p, miR-146a-5p, and miR-181a-5p and downregulation of miR-130b-3p, miR-342-3p, and miR-574-3p) were observed in pregnancies with the occurrence of a miscarriage or stillbirth. The screening based on the combination of these nine microRNA biomarkers revealed 99.01% cases at a 10.0% false positive rate (FPR). The predictive model for miscarriage only was based on the altered gene expressions of eight microRNA biomarkers (upregulation of miR-1-3p, miR-16-5p, miR-17-5p, miR-26a-5p, miR-146a-5p, and miR-181a-5p and downregulation of miR-130b-3p and miR-195-5p). It was able to identify 80.52% cases at a 10.0% FPR. Highly efficient early identification of later occurrences of stillbirth was achieved via the combination of eleven microRNA biomarkers (upregulation of miR-1-3p, miR-16-5p, miR-17-5p, miR-20a-5p, miR-146a-5p, and miR-181a-5p and downregulation of miR-130b-3p, miR-145-5p, miR-210-3p, miR-342-3p, and miR-574-3p) or, alternatively, by the combination of just two upregulated microRNA biomarkers (miR-1-3p and miR-181a-5p). The predictive power achieved 95.83% cases at a 10.0% FPR and, alternatively, 91.67% cases at a 10.0% FPR. The models based on the combination of selected cardiovascular-disease-associated microRNAs had very high predictive potential for miscarriages or stillbirths and may be implemented in routine first-trimester screening programs.
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Affiliation(s)
- Ilona Hromadnikova
- Department of Molecular Biology and Cell Pathology, Third Faculty of Medicine, Charles University, 14700 Prague, Czech Republic
| | - Katerina Kotlabova
- Department of Molecular Biology and Cell Pathology, Third Faculty of Medicine, Charles University, 14700 Prague, Czech Republic
| | - Ladislav Krofta
- Institute for the Care of the Mother and Child, Third Faculty of Medicine, Charles University, 14700 Prague, Czech Republic
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Adgent MA, Vereen S, McCullough A, Jones SH, Torstenson E, Velez Edwards DR, Hartmann KE, Carroll KN. Periconceptional folic acid supplementation and child asthma: a Right From the Start follow-up study. J Matern Fetal Neonatal Med 2022; 35:10232-10238. [PMID: 36117404 PMCID: PMC9810277 DOI: 10.1080/14767058.2022.2122795] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Revised: 07/08/2022] [Accepted: 07/13/2022] [Indexed: 01/05/2023]
Abstract
OBJECTIVE High maternal folic acid exposure has been studied as a risk factor for child asthma with inconclusive results. Folic acid supplementation that begins before pregnancy may propagate high exposures during pregnancy, particularly in regions with fortified food supplies. We investigated whether folic acid supplementation initiated periconceptionally is associated with childhood asthma in a US cohort. MATERIALS AND METHODS We re-contacted mother-child dyads previously enrolled in a prospective pregnancy cohort and included children age 4 to 8 years at follow-up (n = 540). Using first trimester interviews, we assessed whether initial folic acid-containing supplement (FACS) use occurred near/before estimated conception ("periconceptional") or after (during the "first trimester"). Follow-up questionnaires were used to determine if a child ever had an asthma diagnosis ("ever asthma") or asthma diagnosis with prevalent symptoms or medication use ("current asthma"). We examined associations between FACS initiation and asthma outcomes using logistic regression, excluding preterm births and adjusting for child age, sex, maternal race, maternal education, and parental asthma. RESULTS Approximately half of women initiated FACS use periconceptionally (49%). Nine percent of children had "ever asthma" and 6% had "current asthma." Periconceptional initiation was associated with elevated odds of ever asthma [adjusted odds ratio (95% Confidence Interval): 1.65 (0.87, 3.14)] and current asthma [1.87 (0.88, 4.01)], relative to first trimester initiation. CONCLUSION We observed positive, but imprecisely estimated associations between periconceptional FACS initiation and child asthma. Folic acid prevents birth defects and is recommended. However, larger studies of folic acid dosing and timing, with consideration for childhood asthma, are needed.
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Affiliation(s)
- Margaret A. Adgent
- Division of General Pediatrics, Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN
- Vanderbilt Epidemiology Center, Institute for Medicine and Public Health, Vanderbilt University Medical Center, Nashville, TN
- Department of Health Policy, Vanderbilt University Medical Center, Nashville, TN
| | - Shanda Vereen
- Division of General Pediatrics, Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN
- College of Public Health, University of South Florida, Tampa, FL
| | - Alexis McCullough
- Division of General Pediatrics, Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN
| | - Sarah H. Jones
- Vanderbilt Epidemiology Center, Institute for Medicine and Public Health, Vanderbilt University Medical Center, Nashville, TN
- Department of Obstetrics and Gynecology; Vanderbilt University Medical Center, Nashville, TN
- Women’s Health Research at Vanderbilt, Vanderbilt University Medical Center, Nashville, TN
| | - Eric Torstenson
- Department of Epidemiology, Vanderbilt University Medical Center, Nashville, TN
- Vanderbilt Genetics Institute, Vanderbilt University Medical Center, Nashville, TN
| | - Digna R. Velez Edwards
- Vanderbilt Epidemiology Center, Institute for Medicine and Public Health, Vanderbilt University Medical Center, Nashville, TN
- Department of Obstetrics and Gynecology; Vanderbilt University Medical Center, Nashville, TN
- Women’s Health Research at Vanderbilt, Vanderbilt University Medical Center, Nashville, TN
- Vanderbilt Genetics Institute, Vanderbilt University Medical Center, Nashville, TN
| | - Katherine E. Hartmann
- Vanderbilt Epidemiology Center, Institute for Medicine and Public Health, Vanderbilt University Medical Center, Nashville, TN
- Department of Obstetrics and Gynecology; Vanderbilt University Medical Center, Nashville, TN
- Women’s Health Research at Vanderbilt, Vanderbilt University Medical Center, Nashville, TN
| | - Kecia N. Carroll
- Division of General Pediatrics, Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Department of Pediatrics, Kravis Children’s Hospital, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Institute for Exposomic Research, Icahn School of Medicine at Mount Sinai, New York, NY
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Wang X, Wang G, Han R, Gao M, Wang F, Hong Y, Chen Q. Uterine fibroids increase the risk of preterm birth and other adverse birth events: a systematic review and meta-analysis. Transl Pediatr 2022; 11:978-986. [PMID: 35800281 PMCID: PMC9253953 DOI: 10.21037/tp-22-215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Accepted: 06/14/2022] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Uterine fibroids may cause preterm birth. This meta-analysis evaluates the effect of uterine fibroids on the risk of preterm birth and other obstetric outcomes. METHODS Using the literature review method, the databases PubMed, Medline, Embase and Central were retrieved to obtain relevant research literature. The selected studies were analyzed and evaluated. The literature was a cohort study or a case-control study of pregnant women as the research object and uterine fibroids as the exposure factor to observe adverse events during pregnancy. The chi-square test was used to test for heterogeneity. Subgroup analyses were used to explore sources of heterogeneity. Publication bias was assessed using Egger's test. Enumeration data were described by odds ratio (OR). Measurement data were described by mean difference (MD). Calculate the confidence interval (CI). RESULTS A total of 11 studies were included in this study, including 7 cohort studies and 4 case-control studies, with a total of 313,913 women. The probability of uterine fibroids among women was 3.99%. The results of meta-analysis showed that women with uterine fibroids experienced preterm birth <37 weeks (OR =1.43, 95% CI: 1.25 to 1.64, P<0.00001), preterm birth <34 weeks (OR =1.73, 95% CI: 1.34 to 2.25, P<0.0001), premature rupture of membranes (OR =1.38, 95% CI: 1.08 to 1.75, P=0.009), placental abruption (OR =1.60, 95% CI: 1.20 to 2.14, P=0.001), cesarean section (OR =2.09, 95% CI: 1.69 to 2.58, P<0.00001), and postpartum hemorrhage (OR =2.95, 95% CI: 1.86 to 4.66, P<0.00001) were all at higher risk, and the mean gestational age at delivery [mean difference (MD) =-0.58, 95% CI: -0.66 to -0.51, P<0.00001] and birth weight (MD =-117.82, 95% CI: -155.19 to -80.45, P<0.00001) were lower. Egger's test indicated that there was no publication bias among the included studies (P>0.05). CONCLUSIONS Pregnant women with uterine fibroids are at higher risk for preterm birth and other adverse obstetric outcomes and require closer monitoring.
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Affiliation(s)
- Xiuling Wang
- Infection and Disease Control Section, Haikou Maternal and Child Health Hospital, Haikou, China
| | - Gui Wang
- Department of Obstetrics and Gynecology, Tunchang People's Hospital, Tunchang, China
| | - Ru Han
- Department of Obstetrics and Gynecology, Haikou Maternal and Child Health Hospital, Haikou, China
| | - Mei Gao
- Department of Obstetrics, Haikou Maternal and Child Health Hospital, Haikou, China
| | - Fangmin Wang
- Department of Obstetrics and Gynecology, Haikou Hospital of Traditional Chinese Medicine, Haikou, China
| | - Yarong Hong
- Department of Obstetrics and Gynecology, Tunchang People's Hospital, Tunchang, China
| | - Qiuxia Chen
- Department of Obstetrics, Hainan Women and Children's Medical Center, Haikou, China
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Tîrnovanu MC, Lozneanu L, Tîrnovanu ŞD, Tîrnovanu VG, Onofriescu M, Ungureanu C, Toma BF, Cojocaru E. Uterine Fibroids and Pregnancy: A Review of the Challenges from a Romanian Tertiary Level Institution. Healthcare (Basel) 2022; 10:healthcare10050855. [PMID: 35627994 PMCID: PMC9141014 DOI: 10.3390/healthcare10050855] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2022] [Revised: 04/28/2022] [Accepted: 05/04/2022] [Indexed: 12/04/2022] Open
Abstract
Background and Objectives. Uterine fibroids are relatively common in reproductive-age women and are directly linked to pregnancy. There are many debates about performing a myomectomy at the same time as a caesarian section (CS) in such cases due to the risk of a hemorrhage. Our study aims to investigate fibroid features and their evolution in pregnancy, complications of a myomectomy during CS and maternal and fetal obstetric outcomes of pregnancies with fibroids. Materials and methods. We realize a prospective study that includes 57 patients with fibroids in pregnancy diagnosed in January 2017–June 2019. We analyze the number, the location and the growth of fibroids during pregnancy and the maternal and fetal outcome. We appreciate the bleeding in patients with a myomectomy and without a myomectomy during CS, using hemoglobin values before and after birth. Results. Most of the patients present single fibroids that are 30–160 mm in size, located on the anterior uterine wall. Vaginal delivery is used in 7% of women, whereas 85.96% deliver by CS. In addition, 68% of fibroids are diagnosed in the first trimester. In most cases, the fibroid has maximum growth in the second trimester of pregnancy. The myomectomy rate for fibroids during CS is 24.48. Hemoglobin values showed no statistically significant difference between the two groups with and without myomectomy. The operating time is double for the group with a myomectomy associated with a CS. The results of the obstetric outcomes are abortion in 7% of all patients, whereas premature delivery and births at term are 9.43% and 90.57%, respectively. Conclusions. The decision of performing a myomectomy during pregnancy can be a challenge and must be performed for selected cases. This procedure may have several benefits, such as avoiding another operation to remove fibroids.
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Affiliation(s)
- Mihaela Camelia Tîrnovanu
- Department of Mother and Child Medicine, “Grigore. T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania; (M.C.T.); (V.G.T.); (M.O.); (B.F.T.)
- 1st Clinic of Obstetric and Gynecology, Cuza Voda Obstetrics-Gynecology Clinic Hospital, 700038 Iaşi, Romania
| | - Ludmila Lozneanu
- Department of Morphofunctional Sciences I, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania;
- Correspondence: (L.L.); (C.U.); Tel.: +40-744-341-459 (L.L.); +40-722-408-889 (C.U.)
| | - Ştefan Dragoş Tîrnovanu
- Department of Surgery II, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania;
| | - Vlad Gabriel Tîrnovanu
- Department of Mother and Child Medicine, “Grigore. T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania; (M.C.T.); (V.G.T.); (M.O.); (B.F.T.)
- 1st Clinic of Obstetric and Gynecology, Cuza Voda Obstetrics-Gynecology Clinic Hospital, 700038 Iaşi, Romania
| | - Mircea Onofriescu
- Department of Mother and Child Medicine, “Grigore. T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania; (M.C.T.); (V.G.T.); (M.O.); (B.F.T.)
- 1st Clinic of Obstetric and Gynecology, Cuza Voda Obstetrics-Gynecology Clinic Hospital, 700038 Iaşi, Romania
| | - Carmen Ungureanu
- Department of Morphofunctional Sciences I, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania;
- Correspondence: (L.L.); (C.U.); Tel.: +40-744-341-459 (L.L.); +40-722-408-889 (C.U.)
| | - Bogdan Florin Toma
- Department of Mother and Child Medicine, “Grigore. T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania; (M.C.T.); (V.G.T.); (M.O.); (B.F.T.)
- 1st Clinic of Obstetric and Gynecology, Cuza Voda Obstetrics-Gynecology Clinic Hospital, 700038 Iaşi, Romania
| | - Elena Cojocaru
- Department of Morphofunctional Sciences I, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania;
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Wise LA, Thomas L, Anderson S, Baird DD, Anchan RM, Terry KL, Marsh EE, Wegienka G, Nicholson WK, Wallace K, Bigelow R, Spies J, Maxwell GL, Jacoby V, Myers ER, Stewart EA. Route of myomectomy and fertility: a prospective cohort study. Fertil Steril 2022; 117:1083-1093. [PMID: 35216832 PMCID: PMC9081130 DOI: 10.1016/j.fertnstert.2022.01.013] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Revised: 01/07/2022] [Accepted: 01/11/2022] [Indexed: 12/29/2022]
Abstract
OBJECTIVE To assess prospectively the association between the myomectomy route and fertility. DESIGN Prospective cohort study. SETTING The Comparing Treatments Options for Uterine Fibroids (COMPARE-UF) Study is a multisite national registry of eight clinic centers across the United States. PATIENT(S) Reproductive-aged women undergoing surgery for symptomatic uterine fibroids. INTERVENTION(S) Not applicable. MAIN OUTCOME MEASURE(S) We used life-table methods to estimate cumulative probabilities and 95% confidence intervals (CI) of pregnancy and live birth by the myomectomy route during 12, 24, and 36 months of follow-up (2015-2019). We also conducted 12-month interval-based analyses that used logistic regression to estimate odds ratios and 95% CIs for associations of interest. In all analyses, we used propensity score weighting to adjust for differences across surgical routes. RESULT(S) Among 1,095 women who underwent myomectomy (abdominal = 388, hysteroscopic = 273, and laparoscopic = 434), 202 reported pregnancy and 91 reported live birth during 36 months of follow-up. There was little difference in the 12-month probability of pregnancy or live birth by route of myomectomy overall or among women intending pregnancy. In interval-based analyses, adjusted ORs for pregnancy were 1.28 (95% CI, 0.76-2.14) for hysteroscopic myomectomy and 1.19 (95% CI, 0.76-1.85) for laparoscopic myomectomy compared with abdominal myomectomy. Among women intending pregnancy, adjusted ORs were 1.27 (95% CI, 0.72-2.23) for hysteroscopic myomectomy and 1.26 (95% CI, 0.77-2.04) for laparoscopic myomectomy compared with abdominal myomectomy. Associations were slightly stronger but less precise for live birth. CONCLUSION(S) The probability of conception or live birth did not differ appreciably by the myomectomy route among women observed for 36 months postoperatively. CLINICAL TRIALS REGISTRATION NUMBER: (NCT02260752, clinicaltrials.gov).
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Affiliation(s)
- Lauren A Wise
- Department of Epidemiology, Boston University School of Public Health, Boston, Massachusetts.
| | - Laine Thomas
- Department of Biostatistics, Duke University, Durham, North Carolina
| | - Sophia Anderson
- Department of Biostatistics, Duke University, Durham, North Carolina
| | - Donna D Baird
- Epidemiology Branch, National Institute of Environmental Health Sciences, Durham, North Carolina
| | - Raymond M Anchan
- Department of Obstetrics, Gynecology and Reproductive Biology, Brigham and Women's Hospital, Boston, Massachusetts
| | - Kathryn L Terry
- Department of Obstetrics, Gynecology and Reproductive Biology, Brigham and Women's Hospital, Boston, Massachusetts
| | - Erica E Marsh
- Department of Obstetrics and Gynecology, University of Michigan Medical School, Ann Arbor, Michigan
| | - Ganesa Wegienka
- Department of Public Health Sciences, Henry Ford Health System, Detroit, Michigan
| | - Wanda Kay Nicholson
- Center for Women's Health Research, Department of Obstetrics and Gynecology, UNC School of Medicine, Chapel Hill, North Carolina
| | - Kedra Wallace
- Department of Obstetrics and Gynecology, University of Mississippi Medical Center, Jackson, Mississippi
| | - Robert Bigelow
- Duke Clinical Research Institute, Duke University, Durham, North Carolina
| | - James Spies
- Department of Radiology, MedStar Georgetown University Hospital, Washington, D.C
| | - George L Maxwell
- Department of Obstetrics and Gynecology and the Women's Health Integrated Research Center, Inova Fairfax Hospital, Falls Church, Virginia
| | - Vanessa Jacoby
- School of Medicine, University of California San Francisco, San Francisco California
| | - Evan R Myers
- Department of Obstetrics and Gynecology, Duke University School of Medicine, Durham, North Carolina
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9
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Sundermann AC, Aldridge TD, Hartmann KE, Jones SH, Torstenson ES, Edwards DRV. Uterine fibroids and risk of preterm birth by clinical subtypes: a prospective cohort study. BMC Pregnancy Childbirth 2021; 21:560. [PMID: 34404387 PMCID: PMC8369624 DOI: 10.1186/s12884-021-03968-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Accepted: 06/09/2021] [Indexed: 11/17/2022] Open
Abstract
Background Fibroids are present in approximately one in ten pregnancies and are inconsistently linked with preterm birth. We sought to determine the association between fibroids and preterm birth in a prospective cohort with standardized research ultrasounds for characterizing fibroids in early pregnancy while accounting for the clinical paths that precede preterm birth. Methods Participants who were pregnant or planning a pregnancy were recruited from communities in three states between 2000 and 2012. Members of this prospective cohort had a research ultrasound in the first trimester to establish pregnancy dating and to record detailed information about the presence, size, number, and location of fibroids. Baseline information from time of enrollment and a detailed first trimester interview contributed key information about candidate confounders. Birth outcomes, including clinical classification of type of preterm birth (preterm labor, preterm premature rupture of membranes, and medically indicated preterm birth) were cross-validated from participant report, labor and delivery records, and birth certificate data. Results Among 4,622 women with singleton pregnancies, 475 had at least one fibroid (10.3%) and 352 pregnancies resulted in preterm birth (7.6%). Prevalence of fibroids was similar for women with preterm and term births (10.2% vs. 10.3%). Fibroids were not associated with increased risk of preterm birth after taking into account confounding (risk ratio adjusted for race/ethnicity and maternal age, 0.88; 95% confidence interval, 0.62–1.24) nor any clinical subtype of preterm birth. No fibroid characteristic or combination of characteristics was associated with risk. Conclusions If fibroids increase risk of preterm birth, the effect is substantially smaller than previous estimates. Given lack of effect in a large population of women from the general population, rather than higher risk academic tertiary populations previously most studied, we encourage a reconsideration of the clinical impression that presence of fibroids is a major risk factor for preterm birth.
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Affiliation(s)
- Alexandra C Sundermann
- Vanderbilt Epidemiology Center, Institute for Medicine and Public Health, Vanderbilt University Medical Center, 2525 West End Avenue, Nashville, TN, 37203, USA.,Women's Health Research at Vanderbilt, Vanderbilt University Medical Center, 2525 West End Avenue, Nashville, TN, 37203, USA
| | - Tiara D Aldridge
- Division of Quantitative Sciences, Department of Obstetrics and Gynecology, Vanderbilt University Medical Center, 1211 Medical Center Drive, Nashville, TN, 37212, USA
| | - Katherine E Hartmann
- Vanderbilt Epidemiology Center, Institute for Medicine and Public Health, Vanderbilt University Medical Center, 2525 West End Avenue, Nashville, TN, 37203, USA. .,Women's Health Research at Vanderbilt, Vanderbilt University Medical Center, 2525 West End Avenue, Nashville, TN, 37203, USA. .,Division of Quantitative Sciences, Department of Obstetrics and Gynecology, Vanderbilt University Medical Center, 1211 Medical Center Drive, Nashville, TN, 37212, USA.
| | - Sarah H Jones
- Vanderbilt Epidemiology Center, Institute for Medicine and Public Health, Vanderbilt University Medical Center, 2525 West End Avenue, Nashville, TN, 37203, USA.,Women's Health Research at Vanderbilt, Vanderbilt University Medical Center, 2525 West End Avenue, Nashville, TN, 37203, USA
| | - Eric S Torstenson
- Vanderbilt Epidemiology Center, Institute for Medicine and Public Health, Vanderbilt University Medical Center, 2525 West End Avenue, Nashville, TN, 37203, USA
| | - Digna R Velez Edwards
- Vanderbilt Epidemiology Center, Institute for Medicine and Public Health, Vanderbilt University Medical Center, 2525 West End Avenue, Nashville, TN, 37203, USA.,Women's Health Research at Vanderbilt, Vanderbilt University Medical Center, 2525 West End Avenue, Nashville, TN, 37203, USA.,Division of Quantitative Sciences, Department of Obstetrics and Gynecology, Vanderbilt University Medical Center, 1211 Medical Center Drive, Nashville, TN, 37212, USA
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10
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Coutinho LM, Assis WA, Spagnuolo-Souza A, Reis FM. Uterine Fibroids and Pregnancy: How Do They Affect Each Other? Reprod Sci 2021; 29:2145-2151. [PMID: 34142343 DOI: 10.1007/s43032-021-00656-6] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Accepted: 06/09/2021] [Indexed: 01/20/2023]
Abstract
The present narrative review is aimed to rekindle discussion regarding whether and how uterine leiomyoma and pregnancy may impact each other. Although fibroids are hormone-dependent lesions, their growth during pregnancy seems to have a nonlinear trend. Besides placental estrogens and progesterone, an array of endocrine and paracrine factors affect fibroid blood supply, growth rate, and risk of degeneration along the gestational and puerperal periods. According to current evidence, the presence of leiomyomas might increase the risk of some adverse pregnancy outcomes. Although a causative relation between fibroids and spontaneous abortion is questionable, the presence of multiple submucosal lesions in certain populations, such as infertile women, may increase the risk of pregnancy loss. Slightly increased risks of placenta previa, placental abruption and fetal malpresentation may occur, mainly due to the mechanical influence of multiple and large fibroids. Cesarean section and preterm birth rates are also probably increased in the presence of fibroids. The risk associations are based on meta-analyses of cohort studies (level of evidence 2a), retrospective cohort studies (2b), case-control (3a), and cross-sectional studies (3b), but with a predominantly low risk of bias. For evaluating the growth pattern of leiomyomas and their real influence on obstetric outcomes, future studies should enroll women with fibroids diagnosed prior to pregnancy and follow them prospectively throughout the gestation and puerperium.
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Affiliation(s)
- Larissa M Coutinho
- Department of Maternal and Child Health, Universidade Federal de Juiz de Fora, Juiz de Fora, Brazil.,Department of Obstetrics and Gynecology, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Wiviane A Assis
- Department of Obstetrics and Gynecology, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Ananda Spagnuolo-Souza
- Department of Obstetrics and Gynecology, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Fernando M Reis
- Department of Obstetrics and Gynecology, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil. .,Division of Human Reproduction, Department of Ob/Gyn, Hospital das Clínicas, UFMG, Av. Alfredo Balena, 110, 9° andar, Belo Horizonte, MG, 30130-100, Brazil.
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11
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Tinelli A, Kosmas IP, Catherino WH, Carugno J, Mynbaev OA, Sparic R, Trojano G, Malvasi A. Laparoscopic Intracapsular Myomectomy in Women 40 Years Old and Over with Symptomatic Uterine Fibroids. A Pilot Study. Surg J (N Y) 2021; 7:e47-e53. [PMID: 33768157 PMCID: PMC7985481 DOI: 10.1055/s-0040-1722657] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Accepted: 11/23/2020] [Indexed: 10/25/2022] Open
Abstract
Authors evaluated the impact of laparoscopic intracapsular myomectomy (LIM) in women 40 years of age and over with desire of future fertility compared with medical management of symptomatic fibroids, by a prospective cohort study in University affiliated Hospitals. This study includes a cohort of women 40 years of age and older with symptomatic intramural fibroids with desire of future fertility. Women with symptomatic fibroid uterus were offered to undergo LIM or medical management. They were encouraged to attempt conception either spontaneously or by assisted reproductive technology (ART) according to their individual preference. All women were followed for 2 years. Fibroid characteristics, pre- and post-surgical variables, including surgical complications, days of hospitalization, pregnancy rate, and obstetrical outcomes were collected. A total of 100 patient were included in the analysis. Fifty patients were assigned to the LIM group and 50 to the medical treatment group (MT). Groups were similar regarding age (43.5 ± 2.4 and 43.5 ± 2.4, p = 0.99), body mass index (23.8 ± 3.1 and 24.2 ± 3.1, p = 0.54), parity (0.46 ± 0.09 and 0.58 ± 0.09, p = 0.37), fibroid number (1.38 ± 0.6 and 1.46 ± 0.6, p = 0.53), and fibroid size (5.92 ± 1.62 cm vs. 5.94 ± 1.49 cm, p = 0.949). Of the patients who underwent LIM, 62% conceived within the study period compared with 56% in the control group ( p = 0.54). Pregnancy was achieved by ART in 44% of the patients of the LIM group and 30% in control group. There was no significant difference in pregnancy rates among the two groups regarding spontaneous pregnancy rate ( p = 0.332), nor in pregnancies obtained by ART with own eggs ( p = 0.146) and oocyte or embryo donation ( p = 0.821). The take home baby rate was 65% (20/31) in the LIM group and 61% (17/28) in the control group ( p = 0.7851). Both groups had similar rate of miscarriage ( p = 0.748). Patients 40 years old and over with symptomatic fibroid uterus who undergo LIM have similar subsequent fertility and obstetrical outcomes than women treated with medical management. LIM has no detrimental impact on future fertility in women 40 years old and over.
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Affiliation(s)
- Andrea Tinelli
- Department of Obstetrics and Gynecology, "Veris delli Ponti" Hospital, Scorrano, Lecce, Italy
| | - Ioannis P Kosmas
- Department of Obstetrics and Gynecology, Ioannina State General Hospital G. Hatzikosta, University of Ioannina, Ioannina, Greece
| | - William H Catherino
- Department of Obstetrics and Gynecology, Uniformed Services, University of the Health Sciences, Bethesda, Maryland
| | - Jose Carugno
- Division of Minimally Invasive Gynecology, Department of Obstetrics, Gynecology and Reproductive Science, University of Miami, Miller School of Medicine, Miami, Florida
| | - Ospan A Mynbaev
- Laboratory of Human Physiology, Phystech BioMed School, Faculty of Biological & Medical Physics, Moscow Institute of Physics and Technology (State University), Dolgoprudny, Moscow Region, Russia
| | - Radmila Sparic
- Clinic for Gynecology and Obstetrics, Clinical Centre of Serbia, School of Medicine, University of Belgrade, Serbia
| | - Giuseppe Trojano
- Department of Obstetrics & Gynecology, Madonna delle Grazie Hospital, Matera, Italy
| | - Antonio Malvasi
- Department of Obstetrics & Gynecology, Santa Maria Hospital, GVM Care & Research, Bari, Italy
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12
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Managing the unmanageable: A qualitative study exploring sonographer experiences of and training in unexpected and difficult news delivery. Radiography (Lond) 2020; 27:369-376. [PMID: 33077330 DOI: 10.1016/j.radi.2020.09.015] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Revised: 09/12/2020] [Accepted: 09/16/2020] [Indexed: 01/11/2023]
Abstract
INTRODUCTION Ultrasound is used to diagnose pregnancy complications such as miscarriage and fetal health conditions. Within the UK, findings identified during ultrasound examination are delivered by sonographers as standard. However, little is known about the experiences of sonographers when delivering unexpected news (DUN), the impact this has on them, or their preferences for training on news delivery. METHODS Qualitative interviews were completed with fourteen sonographers and were analysed using an inductive thematic approach. Key themes were identified. RESULTS Participants said that obstetric ultrasound often involves 'managing' the patient encounter, including: navigating (unrealistic) patient expectations; handling their own responses to unexpected findings; and managing interaction by moderating emotional expression and communication practices to deliver patient-centred and empathic care. Persistent uncertainty of outcomes, prognosis and patient reactions, alongside high workloads, and frequent siloed working, makes DUN challenging for sonographers. DUN was experienced as emotionally burdensome, and sonographers employed personal coping strategies to reduce stress/burnout. However, the greatest mitigation for stress/burnout was support from peers, though accessing this was challenging. Peers were also described as key sources of learning, especially through observation. CONCLUSION Challenges associated with DUN are an enduring experience for sonographers. Facilitating regular ongoing support and training would enable sonographers to cope with negative aspect of the role, including the emotional burden of DUN. IMPLICATIONS FOR PRACTICE Long patient lists are prioritised to deal with high demand for services. However, sonographer wellbeing needs to be a key priority to avoid stress and burnout. This means facilitating protected time to access support from colleagues, multidisciplinary working where possible, and regular access to training to support DUN. Training focusing on communication practices, alongside dealing with emotional burdens of the role would be beneficial.
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13
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Pérez-Roncero GR, López-Baena MT, Ornat L, Cuerva MJ, Garcia-Casarrubios P, Chedraui P, Pérez-López FR. Uterine fibroids and preterm birth risk: A systematic review and meta-analysis. J Obstet Gynaecol Res 2020; 46:1711-1727. [PMID: 32633025 DOI: 10.1111/jog.14343] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2020] [Revised: 04/21/2020] [Accepted: 05/16/2020] [Indexed: 12/18/2022]
Abstract
AIM This study explored the association between the presence of uterine fibroids (UF), as determined by ultrasound, and preterm birth (PB) risk. METHODS Medline, Embase, Cochrane, Scopus and Web of Science databases. Studies reporting women with and without UF demonstrated by an ultrasound exam. The primary outcome was the risk of PB < 37 weeks of gestation in pregnancies with UF diagnosed by an obstetric ultrasound exam. Effects for dichotomous and continuous outcomes are, respectively, reported as risk ratios (RR) or mean differences and their 95% confidence intervals (CI). RESULTS Eighteen studies were included comprising 276 172 pregnancies to whom obstetric ultrasound assessment was performed for the presence/absence of UF. Women with UF were older (mean difference = 2.40 years, 95% CI 0.94-3.85) and were at higher risk of PB before 37 (RR = 1.43, 95% CI 1.27-1.60), 34 (RR = 1.79, 95% CI 1.32-2.42), 32 (RR = 1.94, 95% CI 1.33-2.85) and 28 (RR = 2.17, 95% CI 1.48-3.17) weeks as compared to those without UF (P < 0.01). In addition, women with UF were at higher risk of threatened preterm labor, preterm premature rupture of membranes, fetal malpresentation, placental abruption, lower gestational age and birthweight at delivery and a higher cesarean delivery rate. CONCLUSION Pregnant women with UF are at increased risk of PB and other adverse obstetric outcomes.
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Affiliation(s)
- Gonzalo R Pérez-Roncero
- Red de Investigación de Ginecología, Obstetricia y Reproducción, Instituto de Investigaciones Sanitarias de Aragón, Zaragoza, Spain
| | - María T López-Baena
- Red de Investigación de Ginecología, Obstetricia y Reproducción, Instituto de Investigaciones Sanitarias de Aragón, Zaragoza, Spain
| | - Lía Ornat
- Red de Investigación de Ginecología, Obstetricia y Reproducción, Instituto de Investigaciones Sanitarias de Aragón, Zaragoza, Spain.,Department of Obstetrics and Gynecology, University of Zaragoza Faculty of Medicine, Zaragoza, Spain
| | - Marcos J Cuerva
- Department of Obstetrics and Gynecology, Hospital Universitario La Paz, Madrid, Spain
| | | | - Peter Chedraui
- Instituto de Investigación e Innovación en Salud Integral, Facultad de Ciencias Médicas, Universidad Católica de Santiago de Guayaquil, Guayaquil, Ecuador.,Facultad de Ciencias de la Salud, Universidad Católica Nuestra Señora de la, Asunción, Paraguay
| | - Faustino R Pérez-López
- Red de Investigación de Ginecología, Obstetricia y Reproducción, Instituto de Investigaciones Sanitarias de Aragón, Zaragoza, Spain.,Department of Obstetrics and Gynecology, University of Zaragoza Faculty of Medicine, Zaragoza, Spain
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14
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Zhao SK, Wu P, Jones SH, Torstenson ES, Hartmann KE, Velez Edwards DR. Association of uterine fibroids with birthweight and gestational age. Ann Epidemiol 2020; 50:35-40.e2. [PMID: 32741603 DOI: 10.1016/j.annepidem.2020.06.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2020] [Revised: 06/10/2020] [Accepted: 06/25/2020] [Indexed: 11/19/2022]
Abstract
PURPOSE To determine if fibroids or their characteristics are associated with birthweight and/or gestational age, and to assess the impact of race or ethnicity. METHODS Right from the Start (2000-2012) is a prospective cohort that enrolled women from the southern US in early pregnancy. Transvaginal ultrasounds were used to measure fibroid characteristics and confirm gestational age. Date of birth and birthweight were obtained from vital or medical records. We assessed whether fibroid presence, number, type, and volume were associated with birthweight and/or gestational age using multivariate analysis of covariance, accounting for a priori confounders. RESULTS Among 3926 women, 416 had one or more fibroids. Mean infant birthweight and gestational age were similar among women with and without fibroids. When adjusting for race or ethnicity, all associations were attenuated. Overall, women with and without fibroids had infants of similar birthweight (-20 grams, 95% confidence interval [CI] -77, 36) and gestational age (0.4 days, 95% CI -0.9, 1.8). Women with three or more fibroids were more likely to have lighter infants (-201 grams, 95% CI -345, -58). CONCLUSIONS Race or ethnicity substantially confounds the associations. The clinical belief that uterine fibroids impair fetal growth is supported only by a significant decrease in birthweight for women with multiple fibroids.
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Affiliation(s)
- Sifang Kathy Zhao
- Vanderbilt Epidemiology Center, Vanderbilt University Medical Center, Nashville, TN
| | - Pingsheng Wu
- Department of Medicine, Vanderbilt University Medical Center, Nashville, TN
| | - Sarah H Jones
- Vanderbilt Epidemiology Center, Vanderbilt University Medical Center, Nashville, TN
| | - Eric S Torstenson
- Vanderbilt Epidemiology Center, Vanderbilt University Medical Center, Nashville, TN
| | - Katherine E Hartmann
- Vanderbilt Epidemiology Center, Vanderbilt University Medical Center, Nashville, TN; Division of Quantitative Sciences, Department of Obstetrics and Gynecology, Vanderbilt University Medical Center, Nashville, TN
| | - Digna R Velez Edwards
- Vanderbilt Epidemiology Center, Vanderbilt University Medical Center, Nashville, TN; Division of Quantitative Sciences, Department of Obstetrics and Gynecology, Vanderbilt University Medical Center, Nashville, TN; Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, TN.
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15
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Parry JP, Isaacson KB. Hysteroscopy and why macroscopic uterine factors matter for fertility. Fertil Steril 2019; 112:203-210. [DOI: 10.1016/j.fertnstert.2019.06.031] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2019] [Accepted: 06/21/2019] [Indexed: 10/26/2022]
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16
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Akbari M, Abedin Do A, Yassaee F, Mirfakhraie R. MED12 Exon 1 Mutational Screening in Iranian Patients with Uterine Leiomyoma. Rep Biochem Mol Biol 2019; 8:21-24. [PMID: 31334283 PMCID: PMC6590935] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2019] [Accepted: 02/07/2019] [Indexed: 06/10/2023]
Abstract
BACKGROUND Uterine leiomyoma, also called fibroid, is a benign tumor that arises due to monoclonal transformation of myometrium, the smooth muscle cell layer of the uterus. Fibroids cause several complications including infertility, miscarriage, bleeding, pain, and dysmenorrhea. Recent studies have revealed the role of mutations in MED12 gene exon 2 in various populations; however, the reported frequency of these mutations differs between reports. In addition, it is suggested that mutations in exon 1 may also play a role in leiomyoma. The aim of the present study was to screen for MED12 exon 1 mutations in leiomyoma tissue samples of Iranian patients. METHODS We performed mutational analysis of exon 1 and the flanking intronic regions using multi-temperature single-strand conformational polymorphism (MSSCP) and sequencing analyses in 120 uterine leiomyoma samples. RESULTS No mutations were detected in exon 1 of MED12 in our samples. CONCLUSION According to the literature and the present results, mutations in the MED12 exon 1 are rare. However, we could not ignore the role of these mutations in developing leiomyoma.
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Affiliation(s)
- Mojdeh Akbari
- Department of Medical Genetics, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
| | - Atieh Abedin Do
- Department of Medical Genetics, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
| | - Fakhrolmolouk Yassaee
- Department of Obstetrics and Gynecology, Taleghani Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
| | - Reza Mirfakhraie
- Department of Medical Genetics, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
- Genomic Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
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17
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Hartmann KE, Velez Edwards DR, Savitz DA, Jonsson-Funk ML, Wu P, Sundermann AC, Baird DD. THE AUTHORS REPLY. Am J Epidemiol 2018; 187:1133-1134. [PMID: 29547991 DOI: 10.1093/aje/kwy033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2017] [Accepted: 02/13/2018] [Indexed: 11/12/2022] Open
Affiliation(s)
- Katherine E Hartmann
- Vanderbilt Epidemiology Center, Institute for Medicine and Public Health, Vanderbilt University Medical Center, Nashville, TN
- Department of Obstetrics and Gynecology, Vanderbilt University School of Medicine, Nashville, TN
| | - Digna R Velez Edwards
- Vanderbilt Epidemiology Center, Institute for Medicine and Public Health, Vanderbilt University Medical Center, Nashville, TN
- Department of Obstetrics and Gynecology, Vanderbilt University School of Medicine, Nashville, TN
| | - David A Savitz
- Department of Epidemiology, Brown School of Public Health, Brown University, Providence, RI
- Department of Obstetrics and Gynecology, Brown Alpert Medical School, Brown University, Providence, RI
| | - Michele L Jonsson-Funk
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC
| | - Pingsheng Wu
- Department of Biostatistics, Institute for Medicine and Public Health, Vanderbilt University Medical Center, Nashville, TN
| | - Alexandra C Sundermann
- Vanderbilt Epidemiology Center, Institute for Medicine and Public Health, Vanderbilt University Medical Center, Nashville, TN
- Department of Obstetrics and Gynecology, Vanderbilt University School of Medicine, Nashville, TN
| | - Donna D Baird
- Epidemiology Branch, National Institute of Environmental Health Sciences, National Institutes of Health, Research Triangle Park, NC
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18
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Nezhat CH, Pfeifer S, Bhagavath B, Lindheim SR, Petrozza JC, Chan PTK, Palter SF. RE: "PROSPECTIVE COHORT STUDY OF UTERINE FIBROIDS AND MISCARRIAGE RISK". Am J Epidemiol 2018; 187:1131-1132. [PMID: 29547879 DOI: 10.1093/aje/kwy031] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2017] [Accepted: 10/25/2017] [Indexed: 11/13/2022] Open
Affiliation(s)
- Ceana H Nezhat
- Minimally Invasive Surgery Fellowship Program, Nezhat Medical Center, Atlanta, GA
- Training and Education Program, Northside Hospital, Atlanta, GA
- Department of Gynecology and Obstetrics, School of Medicine, Emory University, Atlanta, GA
- Society of Reproductive Surgeons, Birmingham, AL
| | - Samantha Pfeifer
- Division of Reproductive Endocrine Infertility, Department of Obstetrics and Gynecology, Weill Cornell Medicine, New York, NY
| | - Bala Bhagavath
- Division of Reproductive Endocrine Infertility, Department of Obstetrics and Gynecology, School of Medicine and Dentistry, University of Rochester Medical Center, Rochester, NY
| | - Steven R Lindheim
- Department of Obstetrics and Gynecology, Boonshoft School of Medicine, Wright State University, Dayton, OH
| | - John C Petrozza
- Division of Reproductive Medicine and In Vitro Fertilization, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Peter T K Chan
- Male Reproductive Medicine, Royal Victoria Hospital, Montreal, QC, Canada
- Department of Urology at McGill University, Montreal, QC, Canada
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Leiomyomas in Pregnancy and Spontaneous Abortion: A Systematic Review and Meta-analysis. Obstet Gynecol 2017; 130:1065-1072. [PMID: 29016496 DOI: 10.1097/aog.0000000000002313] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To systematically review studies reporting the risk of spontaneous abortion among pregnant women of typical reproductive potential with and without uterine leiomyomas. DATA SOURCES We searched PubMed, EMBASE, Web of Science, and ClinicalTrials.gov for publications from January 1970 to December 2016. METHODS OF STUDY SELECTION We excluded studies that did not use imaging to uniformly document leiomyoma status of all participants, did not have a comparison group without leiomyomas, or primarily included women seeking care for recurrent miscarriage, infertility care, or assisted reproductive technologies. TABULATION, INTEGRATION, AND RESULTS Two authors independently reviewed eligibility, extracted data, and assigned overall quality ratings based on predetermined criteria. Of 1,469 articles identified, nine were eligible. Five enrolled general obstetric populations and four included women undergoing amniocentesis. In five studies in general obstetric populations that included 21,829 pregnancies (1,394 women with leiomyomas and 20,435 without), only one adjusted for potential confounders. This meta-analysis revealed no increase in risk of spontaneous abortion among those with leiomyomas compared with those without (11.5% compared with 8.0%; risk ratio 1.16, 95% CI 0.80-1.52). When bias from confounding was estimated for nonadjusted studies, the aggregate calculated risk ratio was 0.83 (95% CI 0.68-0.98). CONCLUSION Leiomyoma presence was not associated with increased risk of spontaneous abortion in an analysis of more than 20,000 pregnant women. Failure of prior studies to adjust for confounders may have led to the common clinical belief that leiomyomas are a risk factor for spontaneous abortion.
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Removal of myomas in asymptomatic patients to improve fertility and/or reduce miscarriage rate: a guideline. Fertil Steril 2017; 108:416-425. [DOI: 10.1016/j.fertnstert.2017.06.034] [Citation(s) in RCA: 76] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2017] [Accepted: 06/29/2017] [Indexed: 11/22/2022]
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