Uterine leiomyoma in women of reproductive age: pregnancy and childbirth management (Literature review)

Голяновський, О. В.; Supruniuk, K.V.; Frolov, S.V.

doi:10.30841/2708-8731.3.2021.234244

Cited by 3 publications

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References 40 publications

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“…ISSN 2786-6009 UKRAINIAN JOURNAL HEALTH OF WOMAN 1(170)/2024 кої менструальної кровотечі [11]. Це пов'язано з набряком, посиленням васкуляризації та гіпертрофією м'язів матки і призводить до збільшення розмірів вузлів під час вагітності, що встановлено нашим ретроспективним дослідженням [9]. У молодих жінок (віком 18-25 років) ЛМ часто має активний характер: швидке зростання, утворення множинних леиоміоматозних вузлів, збільшення їхніх розмірів під час вагітності, що значною мірою ускладнює перебіг вагітності та пологів [16].…”

Section: Original Articlesunclassified

“…За даними літератури, частота ускладнень перебігу вагітності та пологів у цієї категорії вагітних становить від 30% до 80% [1,2,6,9,15]. Автори одного популяційного проспективного дослідження з Ізраїлю вивчали слабкість пологової діяльності в жінок із ЛМ і виявили значне збільшення иого частоти в першому періоді пологів [21,22].…”

Section: Original Articlesunclassified

“…І різні характеристики вузлів матки по-різному впливають на акушерські результати. Результатами нашого ретроспективного дослідження підтверджено, що наявність у вагітної ЛМ має прямий корелятивний зв'язок із розродженням шляхом кесаревого розтину (ВШ=4,7; 95%, ДІ: 3,8-5,8), а також за субмукозних та інтрамуральних ЛМ вузлів вірогідність атонічної ППК достовірно зростає (р<0,05) [9].…”

Section: результати дослідження та їх обговоренняunclassified

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Prevention of complications during pregnancy and childbirth in women with uterine leiomyoma

Golyanovskiy,

Supruniuk

2024

UJHW

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Purpose - to evaluate the clinical effectiveness of the proposed preventive and therapeutic complex using modern drugs and organ-preserving methods of surgical treatment in pregnant women with uterine leiomyoma FIGO (International Federation of Gynecology and Obstetrics) type 3-6. Materials and methods. This prospective study was conducted with a comprehensive examination, selection of optimal tactics for pregnancy management and delivery in 70 pregnant women with uterine leiomyoma using the complex developed by us (main group), 41 pregnant women with uterine leiomyoma with standard pregnancy management (comparison group) and 50 pregnant women without uterine leiomyomas in the II-III trimesters of pregnancy and after childbirth at 4 clinical bases of the Department of Obstetrics and Gynecology No. 1 of the Shupyk National Healthcare University of Ukraine for 3 years - 2020-2023. Results. 70 pregnant women of the main group, who used the treatment and prevention complex developed by us, had significantly lower rates of iron deficiency anemia, the frequency of the threat of premature birth, fetal distress, and hypotonic labor compared to the comparison group and approached the rates of the control group (p<0.05). A 1.8-fold decrease in the risk of premature birth among women in the main group was also noted, as well as a 1.3-fold decrease in the cesarean section rate. PPH volume during vaginal delivery and cesarean section in the main group was significantly lower compared to the comparison group (p<0.01) and had no statistical difference with the control group (p>0.05). Conclusions. Pregnant women with uterine leiomyoma have an increased risk of iron-deficiency anemia, the threat of premature birth, weakness in labor, fetal distress, cesarean section, and PPH development. The treatment and prevention complex proposed by us and the optimal technique for performing cesarean sections allowed not only to reduce the frequency of complications during pregnancy and childbirth, but also to reduce the rate of PPH and reduce the indicators of maternal morbidity. The research was carried out in accordance with the principles of the Helsinki Declaration. The study protocol was approved by the Local Ethics Committee of the participating institution. The informed consent of the patient was obtained for conducting the studies. No conflict of interests was declared by the authors.

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Section: Original Articlesunclassified

Section: результати дослідження та їх обговоренняunclassified

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Prevention of complications during pregnancy and childbirth in women with uterine leiomyoma

Golyanovskiy,

Supruniuk

2024

UJHW

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“…М іома матки є найпоширенішою формою доброякісних пухлин матки [1][2][3]. Частота міоми становить 50-60 % у жінок репродуктивного віку, зростаючи до 70 % до п'ятидесятирічного віку [4,5], а у 30 % випадків ці пацієнтки потребують лікування через аномальні маткові кровотечі та тазові больові симптоми. В епідеміологічних дослідженнях з'ясовано, що на розвиток міоми і маніфестацію клінічних проявів впливають вік, генетична детермінанта, відтермінування вагітності, паритет пологів, раннє менархе, надмірне вживання алкоголю, кофеїну.…”

Section: н а д о п о м о г у л і к а р ю -п р а к т и к уunclassified

Influence of hysterectomy due to leiomyoma on woman’s psychological status

Proshchenko

Ventskivska

2023

RHW

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The objective: to study the clinical-psychopathological features and psycho-emotional symptoms and borderline mental disorders in women of reproductive age after hysterectomy due to leiomyoma.Materials and methods. An assessment of the psychological state of 160 women after hysterectomy for leiomyoma was carried out. 90 patients of them (average age – 45.9±1.3 years old) had transvaginal hysterectomy, both classic and laparoscopically assisted one with opportunistic salpingectomy (I group) and 70 patients (average age – 47.2±1.6 years old) – abdominal hysterectomy with opportunistic salpingectomy (II group). The control group included 50 women 45.7±1.3 years old with asymptomatic leiomyoma. Clinical psychopathological, anamnestic and experimental psychological methods were used. Pathopsychological methods included methods of visual presentation of the personality profile using the Minnesota Multifaceted Personality Questionnaire. The survey was conducted at the pre-operative period, during the adaptation period and during 12 months. Statistical processing of monitoring data was carried out according to the φ-criterion using the statistical analysis software package STATISTICA v. 10 and Microsoft Office Excel application. Results. The results of the questionnaire determined that 44 (48.89 %) patients of the I group and 33 (47.14 %) women of the II group had disorders related to anxiety, and 6 (6.67 %) and 5 (7 .14 %) of the patients of both groups, respectively, were diagnosed depression before surgical treatment. After hysterectomy the number of patients with an anxiety disorder increased to 52 (57.78 %) in the I group and 41 (52.57 %) – II group, with depression – to 10 (11.11 %) and 8 (11.43 %) women, respectively. However, the psychopathological analysis with psychologists in 12 months after hysterectomy determined affective symptoms in 11 (15.7±7.0 %), and latent depression with a somatopsychic correlation, manifested by a feeling palpitation, cardialgias, vegetative disorders was found in 8 (11.4±6.0 %) cases. The type of personality accentuation influenced the development of psychoemotional manifestations. In this structure, the largest rate consisted of psychoasthenic and hysterical character traits. The age of the patient was important when analyzing additional psychological factors. Women under 44 years old associated hysterectomy with loss of femininity with premature aging of the organism. The patients with successful implementation of their role in the family and society had better postoperative psychological adaptation.Conclusions. There is a trend toward an increased number of anxiety and depressive disorders after hysterectomy in women with leiomyoma. After 12 months, affective symptoms were present in 11 (15.7±7.0 %) cases and in 8 (11.4±6.0 %) cases – hidden depression. Postoperative rehabilitation should include a consultation with a psychologist to identify and treat borderline mental disorders, which will lead to the initiation of compensatory and adaptive reactions of the body and the normalization of the psycho-emotional status.

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“…Частота вагітності на тлі ЛМ варіює від 1,6% до 10,7% залежно від триместра гестації та якості методів діагностики, причому частіше цю патологію виявляють у вагітних пізнього фертильного віку [21]. Лише 42% вузлів діагностують клінічно за вагітності, серед яких лейоміоми менше 5 см становлять до 12,5% [22][23][24].…”

Section: а к у ш е р с т в оunclassified

Assessment of placental complex function and miscarriage prevention in pregnant women with uterine fibroid

Golyanovskiy

Supruniuk

Frolov

2022

RHW

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The objective: to reduce the frequency of the threat of pregnancy interruption and loss in women with uterine fibroid through treatment prediction and improvement.Materials and methods. A complex examination of 70 pregnant women with uterine fibroid at 15-16 weeks of pregnancy (main group) and 50 pregnant women without uterine fibroid at the same gestational term (control group) was carried out at 4 clinical bases of the Department of Obstetrics and Gynecology N1 of the Shupyk National Healthcare University of Ukraine in the time period of 2020-2022. Pregnant women in the main group were divided into 2 subgroups depending on the type of the nodes: Ia – 39 pregnant women with subserous type of fibroid nodes (type 5-6 according to FIGO) and Ib – 31 pregnant women with intramural fibroid (type 3-4 according to FIGO). The pregnant women in the main group received the complex of developed therapy for pregnancy interruption (micronized progesterone, magnesium preparations, vitamin B6, acetylsalicylic acid), in the control one – the common therapy (bed rest, abstinence from sexual life, micronized progesterone preparations, tranexamic acid).The concentrations of estradiol, progesterone, human chorionic gonadotropin (hCG) were determined in the blood plasma of all persons at 15–16 weeks and 24 weeks of pregnancy.Results. In the II trimester the concentration of estradiol in the blood of pregnant women with intramural uterine fibroid, especially with multiple forms, was significantly higher than in the control group (p<0.05). At the same time, in pregnant women with intramural fibroid node(s) the mean concentration of estradiol exceeded the similar indicator in the group with the subserosal type (p<0.05). These changes indicated the stress of the hormonal function of the placenta and were considered by us as one of the signs of the initial stage of placental dysfunction.With an increase in estradiol concentration, a significant decrease in progesterone amount was noted. Progesterone deficiency was significantly more common in the subgroup of pregnant women with multiple intramural uterine fibroid and nodes in contact with the uterine cavity, especially at the place of placenta attachment (type 3) – 165.24±14.71nmol/l compared to the control group – 219.96±16.63 nmol/l, and with pregnant women with subserosal node(s) – 210.61±18.57 nmol/l (р<0.01), which confirms the threat of abortion and indicates the development of placental dysfunction. In the II trimester of pregnancy the concentration of hCG in women with uterine fibroid was significantly lower than in women without uterine fibroid and especially lower in multiple uterine fibroid. In the women of the main group progesterone and hCG concentrations in the blood plasma normalized (p>0.05) after the treatment, but the level of estradiol in the group of pregnant women with multiple intramural uterine leiomyoma remained significantly higher (p<0.05).Conclusions. Pregnant women with uterine fibroid have an increased risk of placental dysfunction with a disbalance of the main placental hormones: an increase in estradiol concentration and a relative decrease in progesterone and human chorionic gonadotropin, a shift in the estrogen-progesterone balance towards relative hyperestrogenia.The use of medical measures with long-term support with progesterone, magnesium and low doses of acetylsalicylic acid for the prevention of miscarriage in persons with the clinical manifestations of the threat of gestation is quite effective.

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Uterine leiomyoma in women of reproductive age: pregnancy and childbirth management (Literature review)

Cited by 3 publications

References 40 publications

Prevention of complications during pregnancy and childbirth in women with uterine leiomyoma

Prevention of complications during pregnancy and childbirth in women with uterine leiomyoma

Influence of hysterectomy due to leiomyoma on woman’s psychological status

Assessment of placental complex function and miscarriage prevention in pregnant women with uterine fibroid

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