PREGNANCY WITH FIBROIDS AND ITS OBSTETRIC COMPLICATIONS

Abstract

Background: Pregnancy along with a fibroid is a high risk pregnancy which may lead to complicationwith unequal gravity. Objective of this study was to assess the prevalence and obstetric complicationsof fibroids during pregnancy, this cross-sectional study was carried out in the Department ofGynaecology, Unit ‘C’, Ayub Teaching Hospital Abbottabad. Method: Data of all patients whopresented with fibroid during pregnancy during two years, i.e., from Jan 2006 to Dec 2007 wasrecorded on a proforma and analysed using SPPS-12. Results: Thirty patients were diagnosed to havefibroids during pregnancy out of 3468 deliveries, thus prevalence was 0.865% in our hospital. The ageof 50% cases was from 20 to 30 years, and 30 to 35 Year (27%). Twenty-one (70%) belonged to lowsocioeconomic status. Ninety percent patients reached up to term pregnancy between 37 to 40 weeks.Fibroids were found less common in patients in their first pregnancy (8, 23.66%). Twenty-one (70%)patients were delivered by caesarean section, and in 1 (3.33%) patient hysterotomy was performed.Failure to progress and foetal distress was the commonest indication for caesarean section (8, 38.09%)followed by breech presentation (4, 19.04%), cord prolapse (3, 14.28%) and fibroids in the lowersegment (2, 9.52%). Anaemia was the commonest complication (20, 66.66%) followed by postpartumhaemorrhage (PPH) (10, 33.33%). Breech presentation was the commonest malpresentation (4,13.33%) associated with fibroids during pregnancy. Premature rupture of membranes and cord prolapsewas seen in 3 (10%) patients each. Four (13.33%) patients underwent abdominal hysterectomy. Intrauterine growth restriction IUGR was seen in 2 patients (6.66%), 2 patients ended up with abortions, 1patient had a spontaneous pregnancy loss and the other underwent hysterotomy due to low lyingplacenta and heavy bleeding per vaginum. Compound presentation, neglected transverse lie, stuck headof breech, placenta increta, retained placenta, low lying placenta, were the other complicationsoccurring in one patient each. One patient died during anaesthesia. Neonatal outcome was encouragingas 20 (67%) babies were of average birth weight and only 4 (13.33%) babies had low APGAR scoreand needed NICU admission. Perinatal mortality was 37/1000 live births. Conclusion: Pregnancy withfibroids leads to increase in caesarean section rate due to dysfunctional labour and malpresentation.There is also increased incidence of post partum haemorrhage along with associated complication ofanaemia, anaesthesia and surgery.Keywords: Fibroid, leiomyoma, pregnancy