Pritts Elizabeth A
St. Mary's Hospital, Madison, Wisconsin.
Obstet Gynecol. 2025 Jan 1;145(1):39-45. doi: 10.1097/AOG.0000000000005748. Epub 2024 Sep 26.
There is a prevailing opinion by gynecologists, much of it based on expert opinion or anecdotal evidence, that myomas are detrimental to pregnancy. Newer data challenge much of this dogma, but incorrect assumptions remain. Although not impeccable, multiple data address the correlation between myomas and reproduction, and some emerging evidence addresses surgical removal of these myomas and subsequent outcomes. A thorough literature search was performed, and the amassed data were analyzed to answer some of our most important queries about the role that myomas play in pregnancy and delivery. Uterine leiomyomas ultimately decrease in size during late pregnancy and postpartum. Spontaneous abortion rates are similar in women with and without leiomyomas. The data addressing leiomyoma effects on preterm prelabor rupture of membranes, placental abruption, cesarean delivery, and postpartum hemorrhage rates are conflicting, but the best evidence does not show a significant correlation compared with women without myomas. Preterm delivery rates are elevated in women with leiomyomas. Myomectomy does not decrease preterm deliveries and may increase this risk. Women with myomectomies have increased elective cesarean delivery rates and more blood loss at delivery compared with women with leiomyomas in situ.
妇科医生中有一种普遍的观点，其中大部分基于专家意见或轶事证据，即子宫肌瘤对妊娠有害。新的数据对这种教条提出了诸多挑战，但错误的假设仍然存在。尽管并非完美无缺，但多项数据涉及子宫肌瘤与生殖之间的相关性，一些新出现的证据涉及这些子宫肌瘤的手术切除及后续结果。我们进行了全面的文献检索，并对积累的数据进行了分析，以回答一些关于子宫肌瘤在妊娠和分娩中所起作用的最重要问题。子宫平滑肌瘤在妊娠晚期和产后最终会缩小。有子宫肌瘤和没有子宫肌瘤的女性自然流产率相似。关于子宫肌瘤对胎膜早破、胎盘早剥、剖宫产和产后出血率影响的数据相互矛盾，但与没有子宫肌瘤的女性相比，最佳证据并未显示出显著相关性。有子宫肌瘤的女性早产率升高。子宫肌瘤切除术不会降低早产率，反而可能增加这种风险。与原位子宫肌瘤的女性相比，接受子宫肌瘤切除术的女性择期剖宫产率增加，分娩时失血更多。
