Neonatal outcomes in women with sonographically identified uterine leiomyomata.

OBJECTIVE: We sought to compare perinatal outcomes between women with and without leiomyomata. STUDY DESIGN: This is a retrospective cohort study comparing neonatal outcomes in women with and without uterine leiomyomata discovered at routine second trimester obstetric ultrasonography, all of whom delivered at a single institution. Potential confounders such as maternal age, parity, race, ethnicity, medical insurance, previous uterine surgery, fetal presentation, length of labor, mode of delivery, presence of placenta previa, placental abruption, chorioamnionitis, and epidural use were controlled for using multivariable logistic regression. RESULTS: From 1993 to 2003, 15,104 women underwent routine second trimester prenatal ultrasonography, with 401 (2.7%) women identified with at least one leiomyoma. By univariate and multivariable analyses, the presence of leiomyomata was associated with statistically significant increased risks for preterm delivery at <34 weeks [adjusted odds ratio (AOR) 1.7, 95% confidence interval (CI) 1.1-2.6], <32 weeks (AOR 1.9, 95% CI 1.2-3.2), and <28 weeks (AOR 2.0, 95% CI 1.1-3.8). An association with increased risk for intrauterine fetal demise (IUFD) was also demonstrated (AOR 2.7, 95% CI 1.0-6.9). When IUFD was examined before and after 32 weeks' gestation, the finding only persisted at earlier gestational ages (<32 weeks: AOR 4.2, 95% CI 1.2-14.7 vs. >32 weeks: AOR 0.82, 95% CI 0.1-6.2). CONCLUSION: Regardless of maternal age, ethnicity, and parity, pregnant women with leiomyomata are at increased risk for preterm birth and IUFD. This did not translate to lower birth weight outcomes among term patients, suggesting that LBW is more likely due to preterm birth than growth restriction. These results may be useful for preconception and prenatal counseling of women with leiomyomata.

Obstetric outcomes in women with sonographically identified uterine leiomyomata.

OBJECTIVE: To examine the association between leiomyomata and complications during pregnancy, delivery, and the puerperium. METHODS: We conducted a retrospective cohort study comparing pregnancy outcomes in women with and without uterine leiomyomata who underwent routine second trimester obstetric ultrasonography and delivered viable infants at a single institution. Potential confounding variables, including maternal age, weight, ethnicity, parity, gestational age, epidural use, and labor induction, were controlled for using multivariate logistic regression techniques. RESULTS: From 1993 to 2003, 15,104 women underwent routine second trimester prenatal ultrasonography, and 401 (2.7%) women were identified with at least 1 leiomyoma. By univariate and multivariate analyses, the presence of leiomyomata was associated with increased risks for cesarean delivery (adjusted odds ratio [AOR] 1.57, 95% confidence interval [CI] 1.16-2.13), breech presentation (AOR 1.64, 95% CI 1.11-2.40), malposition (AOR 1.59, 95% CI 1.18-2.15), preterm delivery (AOR 1.45, 95% CI 1.08-1.96), placenta previa (AOR 1.86, 95% CI 1.02-3.39), and severe postpartum hemorrhage (AOR 2.57, 95% CI 1.54-4.27). Premature rupture of membranes, operative vaginal delivery, chorioamnionitis, and endomyometritis were not associated with leiomyomata. Median length of labor was not different between the 2 groups. When compared with leiomyomata less than 10 cm in size, leiomyomata 10 cm or larger were associated with rates of cesarean delivery that were not statistically different (25% compared with 31%, P = .49). CONCLUSION: Pregnant women with leiomyomata are at increased risk for cesarean delivery, breech presentation, malposition, preterm delivery, placenta previa, and severe post partum hemorrhage. Women with leiomyomata 10 cm or larger achieve a vaginal delivery rate of nearly 70%. These results are useful for preconception and prenatal counseling of women with leiomyomata. LEVEL OF EVIDENCE: II-2.