Pregnancy and childbirth in women with multiple uterine fibroids
Tyurina N.A., Viryasova A.A., Otochina N.A., Kuznetsova A.A., Chepoy M.O., Toporkova V.R.
Multiple uterine fibroids (MUFs) are benign hormone-dependent neoplasms with two or more myomatous nodes that affect all stages of the reproductive process. The article presents the analysis of literature data and aims at studying the clinical aspects of complications during the gestational period, delivery and postpartum course in women with MUFs. This pathology has been found to be associated with an increased risk of gestational complications, including spontaneous miscarriage, preterm labor and placental dysfunction. The labor process in patients with MUFs is often complicated by poor uterine contractility and the need for operative delivery. In the postpartum period, uterine hypotonia or atony, massive hemorrhage, infectious and inflammatory complications as well as delayed recovery processes are observed. The article discusses the various factors that determine the prognosis for both mother and child. These factors include the size, localization and number of myomatous nodes. It is evident that personalized approach to the management of patients diagnosed with MUFs is necessary. The paper discusses the association of MUFs with a high incidence of caesarean section due to anatomical changes in the uterus and poor contractility of the myometrium. Infectious and inflammatory complications requiring antibiotic therapy and intensive monitoring are described. It is necessary to conduct further studies in order to identify risk factors and develop clinical guidelines for improving perinatal outcomes in female patients.
Conclusion: The reproductive process in women with MUFs is characterized by an increased risk of complications affecting the gestational, intrapartum and postnatal periods. The patients with this pathology are more likely to have preterm labor, placental dysfunction and other gestational complications, which require careful monitoring during the whole gestational period. Labor in women with MUFs is often accompanied by the need for operative delivery, especially in case of large or low-lying nodes. The postpartum period is characterized by an increased risk of uterine hypotonia, massive hemorrhage and infectious and inflammatory complications that require an individualized approach to monitoring and therapy.
Authors’ contributions: Tyurina N.A., Viryasova A.A. – developing the concept and design of the study; Otochina N.A., Kuznetsova A.A., Chepoy M.O., Toporkova V.R. – collecting and processing the material; Viryasova A.A., Otochina N.A., Kuznetsova A.A. – writing the text; Tyurina N.A., Viryasova A.A., Chepoy M.O. – editing the article.
Conflicts of interest: The authors declare that there are no conflicts of interest.
Funding: The study was conducted without sponsorship.
For citation: Tyurina N.A., Viryasova A.A., Otochina N.A., Kuznetsova A.A., Chepoy M.O., Toporkova V.R.
Pregnancy and childbirth in women with multiple uterine fibroids.
Akusherstvo i Ginekologiya/Obstetrics and Gynecology. 2025; (4): 158-163 (in Russian)
https://dx.doi.org/10.18565/aig.2024.312
Keywords
multiple uterine fibroids
gestational complications
delivery
caesarean section
postpartum period
uterine hypotonia
placental dysfunction
infectious complications
References
- Карамян Р.А., Ордиянц И.М., Хорольский В.А., Асатрян Д.Р. Миома матки: взгляд на проблему. Медицинский вестник Юга России. 2022; 13(2): 18-25. [Karamyan R.A., Ordiyats I.M., Khorolskiy V.A., Asatryan D.R. Uterine fibroids: a look at the problem. Medical Herald of the South of Russia. 2022; 13(2): 18-25. (in Russian)]. https://dx.doi.org/10.21886/2219-8075-2022-13-2-18-25.
- Слюсарева О.А., Маркаров А.Э., Апресян С.В., Доброхотова Ю.Э., Хлынова С.А., Димитрова В.И., Папоян С.А., Маркова Э.А. Мультидисциплинарный подход в лечении миомы матки. Медицинский совет. 2023; 17(5): 58-71. [Slyusareva O.A., Markarov A.E., Apresyan S.V., Dobrokhotova Ju.E., Khlynova S.A., Dimitrova V.I., Papoyan S.A., Markova E.A. Multidisciplinary approach in the treatment of uterine fibroids. Medical Council. 2023; 17(5): 58-71. (in Russian)]. https://dx.doi.org/10.21518/ms2023-090.
- Министерство здравоохранения Российской Федерации. Клинические рекомендации. Миома матки. 2020. [Ministry of Health of the Russian Federation. Clinical guidelines. Uterine fibroids. 2020. (in Russian)].
- Dai Y., Chen H., Yu J., Cai J., Lu B., Dai M. et al. Global and regional trends in the incidence and prevalence of uterine fibroids and attributable risk factors at the national level from 2010 to 2019: A worldwide database study. Chin. Med. J. (Engl.). 2024; 137(21): 2583-9. https://dx.doi.org/10.1097/CM9.0000000000002971.
- Фаткуллин И.Ф., Орлов Ю.В., Фаткуллин Ф.И. Современные подходы к тактике ведения беременности при миоме матки. Медицинский вестник Юга России. 2023; 14(2): 44-51. [Fatkullin I.F., Orlov Y.V., Fatkullin F.I. Modern approaches to the management of pregnancy in uterine myoma. Medical Herald of the South of Russia. 2023; 14(2): 44-51. (in Russian)]. https://dx.doi.org/10.21886/2219-8075-2023-14-2-44-51.
- Девятова Е.А., Цатурова К.А., Вартанян Э.В., Петухова Н.Л., Маркин А.В. Консервативная терапия миомы матки перед лечением бесплодия методом экстракорпорального оплодотворения. Акушерство и гинекология. 2017; 3: 131-8. [Devyatova E.A., Tsaturova K.A., Vartanyan E.V., Petukhova N.L., Markin A.V. Conservative therapy of uterine fibroids prior to in vitro fertilization treatment for infertility. Obstetrics and Gynecology. 2017; (3): 131-8. (in Russian)]. https://dx.doi.org/10.18565/aig.2017.3.131-8.
- Доброхотова Ю.Э., Хачатрян А.С., Ильина И.Ю., Ибрагимова Д.М., Нариманова М.Р., Платова Е.С., Каусева О.И. Течение беременности и родов у пациенток с миомой матки. Архив акушерства и гинекологии им. В.Ф. Снегирёва. 2025; 12(1): 5-14. [Dobrokhotova Yu.E., Khachatryan A.S., Ilyina I.Yu., Ibragimova D.M., Narimanova M.R., Platova E.S., Kauseva O.I. Pregnancy and labor in patients with uterine fibroids. V.F. Snegirev Archives of Obstetrics and Gynecology. 2025; 12(1): 5-14. (in Russian)]. https://dx.doi.org/10.17816/aog630676.
- Yang Q., Ciebiera M., Bariani M.V., Ali M., Elkafas H., Boyer T.G. et al. Comprehensive review of uterine fibroids: developmental origin, pathogenesis, and treatment. Endocrin. Rev. 2022; 43(4): 678-719. https://dx.doi.org/10.1210/endrev/bnab039.
- Marsh E.E., Wegienka G., Williams D.R. Uterine fibroids. JAMA. 2024; 331(17): 1492-3. https://dx.doi.org/10.1001/jama.2024.0447.
- Grube M., Neis F., Brucker S.Y., Kommoss S., Andress J., Weiss M. et al. Uterine fibroids - current trends and strategies. Surg. Technol. Int. 2019; 34: 257-63.
- Machado-Lopez A., Simón C., Mas A. Molecular and cellular insights into the development of uterine fibroids. Int. J. Mol. Sci. 2021; 22(16): 8483. https://dx.doi.org/10.3390/ijms22168483.
- Alkhrait S., Malasevskaia I., Madueke-Laveaux O.S. Fibroids and fertility. Obstet. Gynecol. Clin. North Am. 2023; 50(4): 663-75. https://dx.doi.org/10.1016/j.ogc.2023.08.006.
- Coutinho L.M., Assis W.A., Spagnuolo-Souza A., Reis F.M. Uterine fibroids and pregnancy: How do they affect each other? Reprod. Sci. 2022; 29(8): 2145-51. https://dx.doi.org/10.1007/s43032-021-00656-6.
- Tîrnovanu M.C., Lozneanu L., Tîrnovanu Ş.D., Tîrnovanu V.G., Onofriescu M., Ungureanu C. et al. Uterine fibroids and pregnancy: a review of the challenges from a Romanian tertiary level institution. Healthcare (Basel). 2022; 10(5): 855. https://dx.doi.org/10.3390/healthcare10050855.
- Shi L., Zhang R., Tao S., Yuan X., Zhang J., Wang B. et al. Efficacy and safety of ultrasound-guided high-intensity focused ultrasound ablation in women with multiple uterine fibroids: an exploratory study. Ultrasound Med. Biol. 2023; 49(11): 2378-87. https://dx.doi.org/10.1016/j.ultrasmedbio.2023.08.001.
- Delli Carpini G., Morini S., Papiccio M., Serri M., Damiani V., Grelloni C. et al. The association between childbirth, breastfeeding, and uterine fibroids: an observational study. Sci. Rep. 2019; 9(1): 10117. https://dx.doi.org/10.1038/s41598-019-46513-0.
- Sundermann A.C., Aldridge T.D., Hartmann K.E., Jones S.H., Torstenson E.S., Edwards D.R.V. Uterine fibroids and risk of preterm birth by clinical subtypes: a prospective cohort study. BMC Pregnancy Childbirth. 2021; 21(1): 560. https://dx.doi.org/10.1186/s12884-021-03968-2.
- Фоминова Г.В., Ляличкина Н.А., Косенко Ю.Ю., Фоминова И.С., Захаров А.А. Течение гестационного процесса и родоразрешение пациенток с миомой матки. Современные проблемы науки и образования. 2018; 4: 138. [Fominova G.V., Lanichkina N.A., Kosenko Y.Y., Fominova I.S., Zakharov A.A. During the gestational process and delivery in patients with uterine myoma. Modern problems of science and education. 2018; (4): 138. (in Russian)].
- Li H., Hu Z., Fan Y., Hao Y. The influence of uterine fibroids on adverse outcomes in pregnant women: a meta-analysis. BMC Pregnancy and Childbirth. 2024; 24(1): 345. https://dx.doi.org/10.1186/s12884-024-06545-5.
- Баев О.Р. Применение карбетоцина для профилактики послеродовых кровотечений. Акушерство и гинекология. 2013; 7: 101-5. [Bayev O.R. Use of carbetocin for preventing postpartum hemorrhage. Obstetrics and Gynecology. 2013; (7): 101-5. (in Russian)].
- Ivleva N.A., Tyurina N.A., Kidyaeva I.A., Suvanov B.S., Volgin Y.Y. Features of delivery and course of postpartum period in women with uterine fibroids during premature birth. J. Med. Chem. Sci. 2022; 5(1): 27-34. https://dx.doi.org/10.26655/JMCHEMSCI.2022.1.4.
- Kabodmehri R., Etezadi A., Sharami S.H., Ghanaei M.M., Hosseinzadeh F., Heirati S.F.D. et al. The association between chronic endometritis and uterine fibroids. J. Family Med. Prim. Care. 2022; 11(2): 653-9. https://dx.doi.org/10.4103/jfmpc.jfmpc_1470_21.
- Višnić A. The characteristics of a fibroid in pregnancy can influence the perinatal outcome. Arch. Gynecol. Obstet. 2024; 310(4): 1905-18. https://dx.doi.org/10.1007/s00404-024-07697-7.
- Yaghoubian Y.C., Prasannan L., Alvarez A., Gerber R.P., Galagedera N., Blitz M.J. Fibroid size and number and risk of postpartum hemorrhage. Am. J. Obstet. Gynecol. 2023; 229(3): 344-5. https://dx.doi.org/10.1016/j.ajog.2023.05.001.
Received 05.12.2024
Accepted 24.03.2025
About the Authors
Natalуa A. Tyurina, PhD, Associate Professor at the Department of Obstetrics and Gynecology named after Prof. A.P. Marusov, Ogarev National Research Mordovia State University, 430005, Russia, Saransk, Bolshevistskaya str., 68, natali.belle@rambler.ru, https://orcid.org/0000-0001-5933-4089Anastasia A. Viryasova, specialist degree, Ogarev National Research Mordovia State University, 430005, Russia, Saransk, Bolshevistskaya str., 68,
nastia.pankova2015@yandex.ru, https://orcid.org/0000-0002-3228-3880
Natalya A. Otochina, specialist degree, Ogarev National Research Mordovia State University, 430005, Russia, Saransk, Bolshevistskaya str., 68, otochina.nata@yandex.ru, https://orcid.org/0009-0000-5575-7201
Anastasia A. Kuznetsova, specialist degree, Ogarev National Research Mordovia State University, 430005, Russia, Saransk, Bolshevistskaya str., 68, nastuqsha2003@bk.ru, https://orcid.org/0009-0007-9140-3831
Mihail O. Chepoy, specialist degree, Ogarev National Research Mordovia State University, 430005, Russia, Saransk, Bolshevistskaya str., 68, misha.chepoy@icloud.com,
https://orcid.org/0000-0002-7323-20
Valeria R. Toporkova, specialist degree, Ogarev National Research Mordovia State University, 430005, Russia, Saransk, Bolshevistskaya str., 68, lera.udarova@mail.ru,
https://orcid.org/0009-0003-5579-977X
Corresponding author: Natalуa A. Tyurina, natali.belle@rambler.ru
Similar Articles
