Preferred mode of delivery in pregnancies co-existing with uterine fibroids

Abstract

Background: Uterine fibroids are benign tumours of the Uterus, affecting women in the reproductive age group. Uterine fibroids can co-exist with pregnancy and may cause adverse effects in pregnancy. The mode of delivery of pregnancies co-existing with fibroids contributes significantly to the outcome of these pregnancies. Available data in literature is inconsistent on the preferred mode of delivery in pregnancies with co-existing uterine fibroids. There is the need to know the preferred mode of delivery in pregnant women with co-existing fibroid in our region. This will aid counselling of these patients regarding the mode of delivery.Objective: This study aimed to determine the effect of mode of delivery of pregnancies co-existing with uterine fibroids on pregnancy outcomes. It also assessed if elective (Planned) caesarean section improves foeto-maternal outcome in pregnancies with co-existing uterine fibroids.Materials and Method: This was a retrospective cross-sectional study that reviewed the mode of delivery in 1,337 pregnant women with co-existing uterine fibroids at the Rivers State University Teaching Hospital between January 2017 and December 2021. Antenatal ultrasound scan detected uterine fibroids co-existing with pregnancy in these women. Data was extracted from the hospital records of these patients using a proforma. Data obtained was analysed using IBM SPSS version 25.0 for Windows®, and presented using frequency tables as number and percentages.Results: Out of 9,538 pregnant women who delivered in our facility over the study period, 1,337 of them had co-existing uterine fibroids, giving a prevalence of 14%. The mean age of the paturients was 31.68 ± 5.44 years with their ages ranging from 23 to 47 years. Most of the parturients (67.96%) were nulliparous. Two hundred and five of the women studied (15.73%) had elective caesarean section (C/S), three hundred and fifty-six (26.63%) of the women had emergency caesarean section, while seven hundred and seventy-five (57.97%) of them had vaginal delivery. The total number of women who underwent caesarean delivery was five hundred and sixty-one (42.36%). One hundred and ninety-five (95.12%) of the women who underwent elective caesarean delivery had satisfactory foeto-maternal outcomes, while two hundred and twenty (61.8%) who had emergency caesarean delivery had satisfactory outcome. Four hundred women who had vaginal deliveries had satisfactory foeto-maternal outcomes. From the results, satisfactory foeto-maternal outcome was highest (95.12%) among the group that had planned caesarean section. Conclusion: Uterine fibroids can co-exist with pregnancy, and different characteristics of uterine fibroids affect obstetric outcomes through different ways. Planning the mode of delivery in the antenatal period for women with pregnancies co-existing with uterine fibroids can go a long way to reducing negative obstetric outcomes for mother and baby. Large fibroids (>5 cm diameter), multiple uterine fibroids, or fibroids located in the lower uterine segment may cause labour dystocia, severe PPH, and so require elective caesarean section.