No abstract

Grandmultiparous women had increased maternal and neonatal morbidity, and neonatal mortality even after controlling for confounders, suggesting a need for closer observation than regular multiparous patients during labor and delivery.

Objectives To evaluate intra-observer variability of fibroid sonography measurements, and apply this to assessing fibroid growth. Methods Study participants were young African American women, aged 23–34, who had never been diagnosed with uterine fibroids. All participants underwent transvaginal ultrasound to screen for the presence of previously undiagnosed fibroids (≥0.5 cm diameter). The diameters of up to six fibroids were measured in three perpendicular planes at three separate times during the examination by experienced sonographers. Intra-observer variability as measured by the coefficient of variation (CV) for fibroid diameter and volume was calculated for each fibroid, and factors associated with CV were assessed using regression models. Impact of variability on growth assessment was determined. Results Ninety-six women out of three hundred women screened were found to have at least one fibroid, yielding a total of 174 fibroids for this analysis. The mean CV for the three measurements of fibroid maximum diameter was 5.9. The mean CV for fibroid volume was 12.7. Fibroid size contributed significantly to intra-observer variability, with more variability for smaller fibroids. Fibroid type (submucosal, intramural, subserosal) was not important. Fibroids from the same woman tended to have similar measurement variability when assessed for fibroid volume, but not for fibroid maximum diameter. Calculations showed that when following up fibroids, as much as a 20% increase in diameter could be due to measurement error, not “true growth”. Conclusion A small fibroid must have a larger change in size than a large fibroid to conclude that it is growing, but even for small fibroids an increase in diameter of >20% is likely to indicate “true growth,” not measurement variability.

Purpose To examine the importance of self-reported family history of uterine leiomyoma (fibroids) as a marker of risk. Methods Women, aged 35-49, were randomly selected from the membership of a large urban health plan. Participants completed a self-administered questionnaire about family history of fibroids. Ultrasound screening for fibroids followed, regardless of whether participants had been previously diagnosed (660 black, 412 white). Data for each ethnic group were analyzed separately using Poisson regression. Results In both ethnic groups women who reported a family history of fibroids had an elevated risk of fibroids compared to those without family history. However, no elevated risk was apparent for cases who did not know they had fibroids when they reported the family history information. Conclusions Many women may first learn about their family history of fibroids when discussing their own clinical diagnosis with family members. Such bias would invalidate self-reported family history as a predictor of fibroid risk. As new pharmacological treatments for fibroids are developed, women at high-risk of fibroids would benefit from early screening and pharmacologic-treatment to delay development of large fibroids and reduce the need for invasive treatments. Self-reported family history is not useful for identifying high risk women.