Lviv clinical bulletin 2017, 4(20): 54-59

https://doi.org/10.25040/lkv2017.04.054

Features of giving aid to pregnant women with uterine leiomyoma

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L. Мarkin, О. Besedin, K. Іsayeva

Danylo Halytsky Lviv National Medical University

Introdaction. Nowadays, the combination of pregnancy and uterine leiomyoma has been increased by 20 %. The presence of uterine leiomyoma is associated with a high risk of obstetric and perinatal complications. A lot of studies are dedicated to the search for modern treatment methods. But many issues remain unsolved and controversial, especially regarding surgical treatment of pregnant women with leiomyoma.

Aim. To improve methods of conservative and surgical treatment of pregnant women with uterine leiomyoma in the complicated course of pregnancy due to accomplish maternal and perinatal consequences.

Materials and methods. 47 pregnant women with uterine leiomyoma underwent inpatient treatment due to complicated course of pregnancy and were under observation. Surgery was conducted in 20 (42.6 %) among these patients. The analysis of complaints, anamnestic data, peculiarities of the course of pregnancy and its complications, indications for operation, the course of operation and postoperative period, pathological and anatomical conclusions, the condition of intrauterine fetus and a newborn was conducted to solve tasks.

Results. Previous violation of reproductive function was observed in 78.7 % of pregnant women. The term of pregnancy was in the range from 7 to 36 weeks. All examined women had various pregnancy complications. Threatened miscarriage and threatened preterm labor were in 93.6 % of cases, late gestosis – in 59.6 %, FGRS – in 21.3 %, malposition, malpresentation – in 14.8 %, anemia of pregnant women – in 23.4 % of cases. Complications regarded to leiomyomatous nodes were marked in 32 (68.1 %) of pregnant women, corresponding to the diagnosis of complicated uterine leiomyoma. Prognostically unfavorable course of pregnancy was on the background of large and huge leiomyomatous nodes, multiple uterine leiomyoma particularly with interstitial and subserous interstitial localization.

Pregnancy had been prolonged using pathogenetically-based schemes of treatment and surgical treatment in 45 of pregnant women with uterine leiomyoma and complicated course of pregnancy; subsequent parturition through natural birth happened in 12 (25.5 %) of cases and Caesarean section was conducted in 28 (59.5 %) of cases. Another 5 pregnant women are under observation. Pregnancies have been completed by the birth of living newborns in 40 (95.2 %) of cases.

Conclusions. Apparently, the relevant operating techniques, tactics, post-operative care, preventive and therapeutic measures allow avoiding many intra- and postoperative complications. Leiomyomectomy should be a choice option for pregnant women, which allows prolonging pregnancy and maintaining the reproductive function.

This problem remains relevant and requires further randomized controlled trials to provide the most reliable data and to create regulatory framework with the aim to optimize tactics of conducting pregnant women with this pathology despite significant progress in improving diagnostic and treatment methods of uterine leiomyoma.

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