Exacoustòs C, Rosati P
Department of Obstetrics and Gynecology, Università Cattolica del Sacro Cuore, Rome, Italy.
Obstet Gynecol. 1993 Jul;82(1):97-101.
To evaluate myomas for ultrasound-documented size, location, position, and relation to the placenta, and to relate these findings to complications during pregnancy, at delivery, and in the puerperium.
Among 12,708 pregnant patients who had ultrasound scans, 492 had uterine myomas. Single myomas were found in 88% of cases and multiple myomas in 12%. The myomas were evaluated for size, number, position, location, relationship to the placenta, and echogenic structure, and the outcome of pregnancy was compared to that of patients in the control group.
A statistically significant increased incidence of threatened abortion, threatened preterm delivery, abruptio placentae, and pelvic pain was observed in patients with uterine myomas (P < .001). Abruptio placentae was particularly evident in women with myoma volumes greater than 200 cm3, submucosal location, or superimposition of the placenta. Pelvic pain was related to myoma volume greater than 200 cm3 and ultrasound findings of heterogeneous echo patterns and cystic areas. Mode of delivery, abortion, preterm birth, premature rupture of membranes, and fetal growth did not seem to be affected by the presence of myomas. Thirty-two women with uterine myomas were managed surgically. Thirteen underwent myomectomy during pregnancy. Of these, eight delivered at term and five delivered preterm after the 32nd week of gestation. None of the deliveries were associated with neonatal death. The other 19 patients had surgery at delivery. Nine myomectomies were performed at cesarean delivery. Of these, three were complicated by severe hemorrhage necessitating hysterectomy. Another nine hysterectomies were performed during cesarean and one after vaginal delivery.
In addition to myoma size, the ultrasound evaluation of pregnant women with myomas should include position, location, relationship to the placenta, and echogenic structure. These ultrasound findings make it possible to identify women at risk for myoma-related complications and could be useful in managing the pregnancy.
评估子宫肌瘤的超声测量大小、位置、方位及其与胎盘的关系，并将这些结果与妊娠期间、分娩时及产褥期的并发症相关联。
在12708例接受超声检查的孕妇中，492例患有子宫肌瘤。88%的病例为单发肌瘤，12%为多发肌瘤。评估肌瘤的大小、数量、方位、位置、与胎盘的关系及回声结构，并将妊娠结局与对照组患者的结局进行比较。
子宫肌瘤患者中，先兆流产、先兆早产、胎盘早剥和盆腔疼痛的发生率有统计学意义的显著增加（P <.001）。胎盘早剥在肌瘤体积大于200 cm³、黏膜下位置或胎盘覆盖的女性中尤为明显。盆腔疼痛与肌瘤体积大于200 cm³以及超声显示的不均匀回声模式和囊性区域有关。分娩方式、流产、早产、胎膜早破和胎儿生长似乎不受肌瘤存在的影响。32例子宫肌瘤女性接受了手术治疗。13例在妊娠期间接受了肌瘤切除术。其中，8例足月分娩，5例在妊娠32周后早产。所有分娩均未发生新生儿死亡。另外19例患者在分娩时进行了手术。9例在剖宫产时进行了肌瘤切除术。其中，3例并发严重出血，需行子宫切除术。另外9例子宫切除术在剖宫产时进行，1例在阴道分娩后进行。
对于患有肌瘤的孕妇，超声评估除肌瘤大小外，还应包括方位、位置、与胎盘的关系及回声结构。这些超声检查结果有助于识别有肌瘤相关并发症风险的女性，并对妊娠管理可能有用。
