Milazzo Giusi Natalia, Catalano Angelica, Badia Valentina, Mallozzi Maddalena, Caserta Donatella
Department of Medical and Surgical Sciences and Translational Medicine, Sant'Andrea Hospital, University of Rome "Sapienza", Rome, Italy.
J Obstet Gynaecol Res. 2017 Dec;43(12):1789-1804. doi: 10.1111/jog.13437. Epub 2017 Sep 11.
Summarize the results of the many, but often underpowered, studies on pregnancy complicated by myoma or myomectomy.
Survey of the electronic PubMed database for the last two decades was conducted. We selected reviews, meta-analyses, case series, case reports, clinical studies only with statistical analysis, and guidelines from scientific societies.
Delaying childbearing leads to an increased incidence of pregnancy complicated by fibroids or previous myomectomy. Approximately 10-30% of pregnant women with myomas develop complications during gestation, at delivery and in puerperium. Submucosal, retroplacental, large and multiple myomas have a greater risk of complications. Cervical myomas, although rare, need careful management. The location and size of the fibroids should be assessed from the first trimester. Despite the increased risk of cesarean section, fibroids are not a contraindication to labor, unless they obstruct the birth canal or other obstetric conditions coexist. Myomectomy during pregnancy, in selected cases, is feasible and safe. Myomectomy cannot be considered a prophylactic measure prior to conception, but has to be individualized. Uterine rupture after myomectomy generally occurs in the third trimester or during labor and some associated risk factors have been identified. There is no consensus on the optimal interval between myomectomy and conception.
Pregnancy in patients with fibroids or previous myomectomy should be considered as high risk, requiring a maternal-fetal medicine specialist. To date available literature is inconsistent on evidence-based management. Further research is needed for definitive recommendations.
总结众多关于合并肌瘤或肌瘤切除术的妊娠研究结果，这些研究往往样本量不足。
对过去二十年的电子PubMed数据库进行了检索。我们选择了综述、荟萃分析、病例系列、病例报告、仅进行统计分析的临床研究以及科学协会的指南。
推迟生育会导致合并肌瘤或既往肌瘤切除术的妊娠发生率增加。约10%-30%的肌瘤孕妇在妊娠期、分娩期及产褥期会出现并发症。黏膜下、胎盘后、大的及多发肌瘤发生并发症的风险更高。宫颈肌瘤虽罕见，但需谨慎处理。肌瘤的位置和大小应在孕早期进行评估。尽管剖宫产风险增加，但肌瘤并非分娩的禁忌证，除非其阻塞产道或合并其他产科情况。在特定病例中，孕期肌瘤切除术是可行且安全的。肌瘤切除术不能被视为受孕前的预防措施，而必须个体化。肌瘤切除术后子宫破裂一般发生在孕晚期或分娩期，且已确定了一些相关危险因素。对于肌瘤切除术后与受孕的最佳间隔时间尚无共识。
合并肌瘤或既往肌瘤切除术的患者妊娠应被视为高危妊娠，需要母胎医学专家进行管理。迄今为止，现有文献在循证管理方面并不一致。需要进一步研究以给出明确建议。
