Uterine leiomyomas and pregnancy

Purpose: to evaluate the evolution of pregnancy and the maternofetal prognosis in women with uterine leiomyomas. Methods: a descriptive retrospective analysis of the medical records of 75 pregnant women with leiomyomas attended at the University Hospital, Faculty of Medicine of Ribeirao Preto, University of Sao Paulo, from January 1992 to January 2002. Results: seventy-five pregnant women with leiomyomas were identified in a population of 34,467 pregnant women attended during this period (incidence of 0.2%). The diagnosis was made before pregnancy in 18 patients (24%), during the current pregnancy in 41 (54.6%), and during cesarean section in 16 (21.3%), of whom only six were not submitted to ultrasound scan during the prenatal period. Ten deliveries with preterm fetuses and five cases of premature rupture of the amniotic membranes were observed. Forty-seven patients (75.8%) were submitted to cesarean section, with the indication being directly related to the leiomyomas in 38.3% of them (anomalous presentation, obstruction of the birth canal, or uterine scar due to a previous myomectomy). Four cases of central necrosis, two cases of hyaline degeneration and one case of malignant potential of the leiomyoma were identified in patients submitted to postpartum myomectomy or hysterectomy. Sixty-one newborns (98.4%) had an Apgar score above 7 at the fifth minute of life, and surgery did not lead to a worse maternofetal prognosis when performed during pregnancy. Conclusions: the incidence of leiomyomas during pregnancy was 0.2% during the study period, with ultrasonography failing to diagnose 10 patients. Cesarean section was frequently indicated for this group of patients, but the presence of leiomyomas during pregnancy did not compromise the Apgar score of the newborns.