Uterine Fibroid Torsion during Pregnancy: A Case of

Case ReportUterine Fibroid Torsion during Pregnancy A Case ofLaparotomic Myomectomy at 18 Weeksrsquo Gestation withSystematic Review of the Literature

Annachiara Basso1 Mariana Rita Catalano1 Giuseppe Loverro1

Serena Nocera1 Edoardo Di Naro1 Matteo Loverro1

Mariateresa Natrella2 and Salvatore Andrea Mastrolia1

1Department of Obstetrics and Gynecology Azienda Ospedaliera Universitaria Policlinico di Bari School of MedicineUniversita degli Studi di Bari ldquoAldo Morordquo Bari Italy2School of Nursing Azienda Ospedaliera Universitaria Policlinico di Bari School of MedicineUniversita degli Studi di Bari ldquoAldo Morordquo Bari Italy

Correspondence should be addressed to Salvatore Andrea Mastrolia mastroliasagmailcom

Received 15 January 2017 Revised 17 March 2017 Accepted 20 March 2017 Published 24 April 2017

Academic Editor Maria Grazia Porpora

Copyright copy 2017 Annachiara Basso et al This is an open access article distributed under the Creative Commons AttributionLicense which permits unrestricted use distribution and reproduction in any medium provided the original work is properlycited

Uterine myomas are the most common benign growths affecting female reproductive system occurring in 20ndash40 of womenwhereas the incidence rate in pregnancy is estimated from 01 to 39 The lower incidence in pregnancy is due to the associationwith infertility and low pregnancy rates and implantation rates after in vitro fertilization treatment Uterine myomas usually areasymptomatic during pregnancy However occasionally pedunculated fibroids torsion or other superimposed complications maycause acute abdominal pain There are many controversies in performing myomectomy during cesarean section because of therisk of hemorrhage Nevertheless the majority of indication arises before labor and delivery due to acute symptoms leading to adiscussion regarding the need for intervention during pregnancy Therefore we present a case of successful multiple laparotomicmyomectomy at 17 + 2 weeks of gestational age and a systematic review of the literature in order to clarify the approach to thispathologic condition and its effect on pregnancy outcome

1 Introduction

Uterine myomas are the most common benign growthsaffecting female reproductive system occurring in 20ndash40of women [1] whereas the incidence rate in pregnancy isestimated from 01 to 39The lower incidence in pregnancyis due to the association with infertility and low pregnancyrates and implantation rates after in vitro fertilization treat-ment [2] Uterine myomas usually are asymptomatic dur-ing pregnancy However occasionally pedunculated fibroidstorsion or other superimposed complications may causeacute abdominal pain Urinary and gastroenteric symptomsmay occur due to the rapid increase in size in reason ofhyperestrogenic environment and consequently compres-sion and displacement of surrounding organs Additionallyfibroids predispose to pregnancy complications including

early miscarriage antepartum bleeding preterm labor pre-mature rupture of membranes fetal malpresentations labordystocia and postpartum hemorrhage

Conservative management with anti-inflammatory ther-apy is considered a gold standard and surgery is generallyavoided during pregnancy because of the risks of hysterec-tomy secondary to severe hemorrhage pregnancy injuryand pregnancy loss [3] The main conditions that induceinevitably the surgical procedure are the torsion of peduncu-lated fibroids or rare cases of necrosis resultant inflammatoryperitoneal reaction and finally if symptoms persist after72 hours of pharmacological therapy [4ndash7] Therefore thediagnosis needs a particular attention for the appropriatemanagement choice Surgical removal fibroids in pregnancycan be performed by laparotomy or laparoscopy techniquetaking into account the volume and location of nodules [1 8]

HindawiCase Reports in Obstetrics and GynecologyVolume 2017 Article ID 4970802 11 pageshttpsdoiorg10115520174970802

2 Case Reports in Obstetrics and Gynecology

Laparoscopy can be considered in selected cases such assmall subserous pedunculated myomas

There are many controversies in performing myomec-tomy during cesarean section because of the risk of hem-orrhage [3] Nevertheless the majority of indication arisesbefore labor and delivery due to acute symptoms leadingto a discussion regarding the need for intervention duringpregnancy

Therefore we present a case of successful multiple laparo-tomic myomectomy at 17 + 2 weeks of gestational age anda systematic review of the literature in order to clarifythe approach to this pathologic condition and its effect onpregnancy outcome

2 Case Report

Uterinemyomas are usually asymptomatic during pregnancyHowever pedunculated fibroids torsion may occasionallycause acute abdominal pain [1]

Most cases of laparotomic myomectomy described inliterature have been performed during a cesarean section dueto the risk of managing them surgically at low gestational age[2ndash4] We present a case of a successful multiple laparotomicmyomectomy during the second trimester of pregnancy

A 36-year-old morbidly obese primigravida presentedat our emergency room at 17 + 0 weeks of gestational agecomplaining of abdominal pain At clinical examination theuterus appeared to be of higher volume compared to thegestational age the abdomen was painful but treatable andthe obstetrical examination was normalThe patient was thenreferred to USUnit of our Department for further evaluationThe sonographic assessment revealed the presence of threesubserous uterine myomas located on anterior wall (maxi-mum diameter 132 cm) the right wall (maximum diameter126 cm) and the left wall (maximum diameter 117 cm) ofthe uterus respectively Allmyomaswere vacuolated inside asfor suspected necrosis The scan also showed other multiplemyomas less than 3 cm in size Vital signs were monitored(blood pressure 14090mmHg maternal heart rate 124 bmpSO2 94 apyretic) Amniotic fluid was normal and fetalwell-being was preserved Thus the patient was admitted tothe High-Risk-Pregnancy Unit When collecting the medicalhistory the first trimester ultrasound scan performed at 11weeksrsquo gestation revealed the presence of the same lesionswith a size of 108 cm 102 cm and 614 cm respectively

Laboratory studies demonstrated rising inflammatorymarkers (C-reactive protein 354mgLWBC 1692times 103 120583L)

Due to the persistence of the symptoms despite of twodays of analgesic antispastic and antibiotic therapy aftermultidisciplinary discussion and a thorough counseling toinform the parents of the surgical and postoperative risksconnected with uterine surgery during the gestation thepatient underwent surgery Laparotomy approach by longitu-dinal skin incision considering the volume and the positionof the myomas was performed under general anesthesiaThree huge bulky subserous pedunculated myomas were evi-denced the largest located at the uterine fundus with amaxi-mum diameter of 15 cm and a torsion of its pedicle (Figure 1)Furthermore intra-abdominal adhesions were found within

Figure 1 Myoma of the uterine fundus with evidence of torsion ofits pedicle

peritoneal cavity Blunt dissection was undertaken to free theomentum and look for the appendix which was normal Thethree large myomas evidenced by ultrasound were removedand sent for pathologic examination A pelvic drainage wasleft and removed 24 hours postoperatively Pathology showedwidespread phenomena of necrosis especially in the myomawith torsion of its pedicle

During the following nine days the patient receivedantibiotics low molecular heparin and progesterone andfetal heartbeat was checked daily Considering the improve-ment in clinical condition the patient was discharged with anindication to treatment with progesterone and lowmolecularheparin

Three weeks later at 21 weeksrsquo gestation the patientwas admitted again due to abdominal pain Obstetricalevaluation revealed cervical effacement and the transvagi-nal ultrasound scan showed a reduction of cervical length(18mm) funneling and sludge An ultrasound scan wasperformed showing good fetal variables Consequently thetherapy with progesterone was increased The patient hada positive vaginal culture for Staphylococcus haemolyticusurine culture was negative and C-reactive protein resulted tobe positiveTherefore antibiotic therapy withmacrolides wasgiven according to antibiogram result A cervical cerclagewas proposed to the patient but she refused to undergo theprocedure

Hospitalization lasted for seven days then thewomanwasdischarged due to an improvement of her clinical conditionThe patient underwent obstetric evaluation every two weeksuntil she presented in labor and delivered vaginally at 38+ 1 weeksrsquo gestation a healthy female newborn of 2940 gappropriate for gestational age according to national growthcurves [9] Apgar score was 910 at 11015840 and 51015840 respectively

3 Data Source and Literature Search

To identify potentially eligible studies we searched PubMedScopus and Cochrane Library (all from inception to 16March 2017) No language restrictions were initially appliedWe used a combination of key words and text words repre-sented by ldquomyomectomyrdquo ldquomyomardquo and ldquopregnancyrdquo

Two reviewers (Annachiara Basso and Mariana RitaCatalano) independently screened the titles and abstracts of

Case Reports in Obstetrics and Gynecology 3

1855 records identiedthrough database searching

1611 records aer duplicates were removed

40 full-text articles excludedReasons for exclusion31 linguistic reason9 not retrievable aer international librarian search

104 full-text articlesassessed for eligibility

63 studies included

1611 records screened 1508 records excluded

Iden

tica

tion

Scre

enin

gEl

igib

ility

Inclu

sion

Figure 2 Study selection process

records retrieved through database searches Both reviewersrecommended studies for the full-text review The screenof full-text articles recommended by at least one reviewerwas done independently by the same two reviewers andassessed for inclusion in the systematic review Disagree-ments between reviewers were resolved by consensus For allfull-text manuscripts reference lists were analyzed in orderto find additional eligible studies

4 Results

Theelectronic database search provided a total of 1855 resultsAfter duplicate exclusion there were 1611 citations left Ofthese 1508 were not relevant to the review based on titleand abstract screening 103 studies were considered for full-text assessment of which 40 were excluded for the followingreasons we could not translate 31 articles while nine paperscould not be retrieved even after international librariansearch

Overall 63 [3ndash6 10ndash67] articles were incorporated forfurther assessment The study selection process is shown inFigure 2 The main characteristics of the selected studies areincluded in Table 1

5 Discussion

Our review included 197 women undergoing myomectomyduring pregnancy The procedure was successful in 184women while in the remaining 13 cases a miscarriage or fetaldemise happened after the myomectomy

In 14 cases a laparoscopic approach was chosen in onecase there was a vaginal surgery while all the other casesfor which the surgical information was available underwentlaparotomy These data confirm that the most used surgicalintervention for myomas during pregnancy is the laparotomyroute

Maternal outcomes were favorable after myomectomywith only two episodes of hemoperitoneum [33 67] one uter-ine abscess [39] and only one woman requiring perioperativeblood transfusion [61]

Moreover the analysis of all reports was limited by twofactors (1) the heterogeneity of diagnostic information aswell as descriptive data connected to operation and pathologyexamination which did not allow clear categorization of thepathology preoperatively and postoperatively and (2) thelarge amount of missing or unreported data

6 Conclusion

Myomectomy is a feasible procedure if performed duringpregnancy Candidates need to be chosen carefully amongthose with symptomatic myomas since abdominal surgeryduring pregnancy can be associated with an increased riskfor the development of the great obstetrical syndromesespecially preterm labor and delivery

Disclosure

This paper has been presented in part at the 19th NationalCongress of the Italian Society of Perinatal Medicine (Societa


Table1Ch

aracteris

ticso

fthe

relevant

studies

Reference

Num

bero

fpatie

nts

Gestatio

nalage

atdiagno

sis(w

eeks)

Gestatio

nalage

atmyomectomy

(weeks)

Type

ofsurgery

Fibroidmaxim

umvolume(cm

)Mod

eofd

elivery

Gestatio

nalage

atdelivery

Neonatal

outcom

e(Apgar

birthw

eightpH

)

DeC

arolisetal

2001

18

nd13

LPT

8CS

39883150

gnd

23LP

T40

CS38

882670

gnd

19LP

T14

VD

36893080

gnd

17LP

T21

CS38

893060

gnd

19LP

T15

Fetald

emise

at19

weeks

nd20

LPT

6VD

41992970

gnd

19LP

T12

CS39

793180

gnd

8LP

T9

CS40

993300

gnd

12LP

T8

CS38

9102780g

nd17

LPT

24CS

38993900

gnd

15LP

T10

CS40

8103170g

nd17

LPT

13CS

399103100g

nd6

LPT

15nd

ndnd

nd20

LPT

8CS

399102860g

nd10

LPT

16CS

409103500g

nd16

LPT

10CS

399103930g

nd13

LPT

14CS

39993180

gnd

7LP

T15

CS38

910

-2550g

Dom

enicietal

2014

116

16LP

T20

CS38

89-3

250g

Michalase

tal

1995

114

15LP

T20

CS39

2800

g

Danzere

tal2001

112

12LP

T10

CS37

9103235g

9102810g

Lozzae

tal2011

112

16LP

T18

CS36

992280

gJooetal2001

18

25LP

T12

CS40

3600

g

Celik

etal2002

5

nd22

LPT

13CS

386+minus11

103200g

nd18

LPT

10CS

386+minus11

93400

gnd

20LP

T12

CS386+minus11

10360

0gnd

16LP

T15

CS386+minus11

83100

gnd

13LP

T20

CS386+minus11

92800

gHasbargen

etal

2002

118

18LP

T15

CS36

892495

g

Umezurikea

ndFeyi-W

aboso2005

119

19LP

T32

VD

388103500g

Usifoetal2007

113

13LP

T17

CS38

3990

gSuwandinataetal

2009

1nd

18LP

Tnd

CS37

892950

g


Table1Con

tinued

Reference

Num

bero

fpatie

nts

Gestatio

nalage

atdiagno

sis(w

eeks)

Gestatio

nalage

atmyomectomy

(weeks)

Type

ofsurgery

Fibroidmaxim

umvolume(cm

)Mod

eofd

elivery

Gestatio

nalage

atdelivery

Neonatal

outcom

e(Apgar

birthw

eightpH

)Bh

atlaetal2009

18

19LP

T28

VD

382740

gLeite

etal2009

11sttrim

ester

17LP

T10

CS39

9103315g

Isabuetal2010

114

14LP

Tnd

CS37

2700

gLeachetal2011

111

11LP

T14

CS40

994356

gDoerga-

Bachasingh

etal

2012

19

10LP

T15

CS37

nd

Jhaltaetal2016

113

13LP

T16

VD

39810300

0gKo

smidisetal

2015

110

10LP

S8

ndnd

nd

Saccardi

etal2015

19

15LP

S24

CS41

4460

g72

Obara

etal2014

16

13VA

G6

VD

402775

gCu

rrieetal2013

111

11LP

S8

ndnd

ndKo

bayashietal

2013

121

21LP

T8

CS37

2730

g

MacCioetal2012

38

19LP

S11

CS39

3150

g20

20LP

S10

VD

403310g

2020

LPS

ndCS

393050

gShafiee

etal2012

115

21LP

S15

CS38

ndArdovinoetal

2011

114

14LP

S6

VD

403216g

MullerV

ranjes

etal

114

18LP

T35

CS33

1010

1750g

728

Sonetal2011

118

18LP

S9

VD

393740

gKa

sum

2010

115

15LP

T9

VD

38nd

Fanfanietal2010

125

25LP

S9

VD

402950

gAd

eyem

ietal

2007

119

19LP

T30

VD

397103500g

Okonk

woand

Udigw

e2007

119

24LP

Tnd

CSnd

nd

Draceaa

ndCod

reanu2006

112

13LP

T24

VD

ndnd

Melgratietal2005

124

24LP

S7

VD

3999

6 Case Reports in Obstetrics and GynecologyTa

ble1Con

tinued

Reference

Num

bero

fpatie

nts

Gestatio

nalage

atdiagno

sis(w

eeks)

Gestatio

nalage

atmyomectomy

(weeks)

Type

ofsurgery

Fibroidmaxim

umvolume(cm

)Mod

eofd

elivery

Gestatio

nalage

atdelivery

Neonatal

outcom

e(Apgar

birthw

eightpH

)Sentilh

esetal

2003

117

17LP

S5

CS37

3530

g

Lolis

etal2003

13

nd16

LPT

ndCS

373340

gnd

15LP

Tnd

CS39

3600

gnd

19LP

Tnd

CS37

2970

gnd

16LP

Tnd

CS36

3000

gnd

15LP

Tnd

Fetald

emise

at15

weeks

nd15

LPT

ndCS

372740

gnd

16LP

Tnd

CS38

3180

gnd

16LP

Tnd

CS39

3515g

nd16

LPT

ndCS

393190

gnd

19LP

Tnd

CS38

2920

gnd

17LP

Tnd

CS38

3520

gnd

16LP

Tnd

CS38

3000

gnd

15LP

Tnd

CS29

1606

g

Don

neze

tal2002

1Be

fore

pregnancy

25LP

T22

CS35

2280

g

Williamson

1908

122

22LP

T32

VD

23Neonatald

eath

Stew

art1906

120

20LP

T24

VD

40nd

Wittichetal2000

112

15LP

T20

CS37

993275

gMajid

etal1997

117

18LP

T24

Fetald

emise

19weeks

Algarae

tal2015

118

18LP

S7

VD

24nd

Lockyer1914

121

21LP

Tnd

VD

402300

g

vonHoff

mann1911

316

16LP

Tnd

VD

403630

g22

25LP

Tnd

Fetald

emise

at25

weeks

1415

LPT

ndVD

40nd

And

rews1910

1Be

fore

pregnancy

9LP

Tnd

VD

40nd

Swayne1908

220

20LP

Tnd

ndnd

nd16

16LP

Tnd

VD

24nd

Doran1906

120

21LP

T10

VD

40nd

Evans1899

120

20LP

T7

ndnd

ndEx

acou

stosa

ndRo

sati

1993

13nd

lt26

ndnd

NG

40(8)pretermgt

32(5)

nd

Burton

etal1989

8

nd13

LPT

18VD

40nd

nd15

LPT

14Fetald

emise

15weeks

ndnd

LPT

5VD

40nd

ndnd

LPT

5VD

40nd

ndnd

LPT

5VD

40nd

ndnd

LPT

5VD

40nd

ndnd

LPT

5VD

40nd

ndnd

LPT

5nd

ndnd

Rella

etal1980

110

12LP

Tnd

VD

27Neonatald

eath

Case Reports in Obstetrics and Gynecology 7Ta

ble1Con

tinued

Reference

Num

bero

fpatie

nts

Gestatio

nalage

atdiagno

sis(w

eeks)

Gestatio

nalage

atmyomectomy

(weeks)

Type

ofsurgery

Fibroidmaxim

umvolume(cm

)Mod

eofd

elivery

Gestatio

nalage

atdelivery

Neonatal

outcom

e(Apgar

birthw

eightpH

)Pelosietal1995

113

15LP

S6

CS39

ndPelissie

r-Ko

morek

etal2012

110

13LP

T22

VD

352280

g

Mollicae

tal1996

188ndash17

10ndash19

LPT

gt10

CS(17)V

D(1)

ndgt7(18)gt

2500

g(17)lt

2500

g(1)

Febo

etal1997

3nd

12ndash19

LPT

NG

CS(2)abortio

n(1)

37-38

nd

Bonito

etal2007

5nd

9ndash15

LPT

35ndash145

CS(2)VD(3)

382

9+minus083

3200ndash4

072g

Vazqu

ezCa

macho

etal2009

17

16LP

T62

VD

4099

Makar

etal1989

112

17LP

T13500

gCS

38993950

gHorno

Liria

1962

116

16LP

Tnd

VD

403600

gAlanise

tal2008

17

12LP

T30

VD

382330

g

Ardizzone1955

27

88

LPT

ndnd

ndnd

88

LPT

ndnd

ndnd

88

LPT

ndMisc

arria

geat9weeks

2424

LPT

ndFetald

emise

at25

weeks

88

LPT

ndMisc

arria

geat8weeks

1616

LPT

ndnd

ndnd

88

LPT

ndnd

ndnd

88

LPT

ndnd

ndnd

1212

LPT

ndFetald

emise

at14

weeks

2020

LPT

ndnd

ndnd

1616

LPT

ndnd

ndnd

2020

LPT

ndnd

ndnd

2020

LPT

ndnd

ndnd

1212

LPT

ndnd

ndnd

1212

LPT

ndFetald

emise

at13

weeks

88

LPT

ndnd

ndnd

88

LPT

ndnd

ndnd

1212

LPT

ndFetald

emise

at13

weeks

1212

LPT

ndnd

ndnd

1616

LPT

ndFetald

emise

at17

weeks

88

LPT

ndnd

ndnd

1212

LPT

ndnd

ndnd

1212

LPT

ndnd

ndnd

1212

LPT

ndnd

ndnd

88

LPT

ndnd

ndnd

1212

LPT

ndFetald

emise

at12

weeks

1212

LPT

ndnd

ndnd


Table1Con

tinued

Reference

Num

bero

fpatie

nts

Gestatio

nalage

atdiagno

sis(w

eeks)

Gestatio

nalage

atmyomectomy

(weeks)

Type

ofsurgery

Fibroidmaxim

umvolume(cm

)Mod

eofd

elivery

Gestatio

nalage

atdelivery

Neonatal

outcom

e(Apgar

birthw

eightpH

)

Cozzi1967

16

nd12

LPT

ndVD

40nd

nd12

LPT

ndVD

40nd

nd8

LPT

ndVD

40nd

nd8

LPT

ndVD

40nd

nd16

LPT

ndVD

38nd

nd8

LPT

ndVD

40nd

nd12

LPT

ndVD

38nd

nd8

LPT

ndVD

40nd

nd16

LPT

ndVD

40nd

nd20

LPT

ndVD

36nd

nd8

LPT

ndVD

40nd

nd12

LPT

ndVD

40nd

nd12

LPT

ndVD

40nd

nd12

LPT

ndVD

40nd

nd16

LPT

ndVD

40nd

nd8

LPT

ndVD

40nd

Rochetetal1964

14nd

ndLP

T10

ndnd

ndSciann

ameo

etal

1996

120

20LP

T4

ndnd

nd

ndnot

determ

inedC

Scesarean

section

VDvaginaldeliveryLP

TlaparotomyLP

Slap

aroscopyV

AGvaginalsurgery


Italiana di Medicina Perinatale SIMP) Naples (Italy) 19ndash21January 2017

Conflicts of Interest

The authors declare that there are no conflicts of interest

References

[1] S G Vitale A Tropea D Rossetti M Carnelli and A CiancildquoManagement of uterine leiomyomas in pregnancy review ofliteraturerdquo Updates in Surgery vol 65 no 3 pp 179ndash182 2013

[2] S K Sunkara M Khairy T El-Toukhy Y Khalaf and ACoomarasamy ldquoThe effect of intramural fibroids without uter-ine cavity involvement on the outcome of IVF treatment asystematic review and meta-analysisrdquo Human Reproductionvol 25 no 2 pp 418ndash429 2010

[3] V Lozza A Pieralli S Corioni M Longinotti and C PennaldquoMultiple laparotomic myomectomy during pregnancy a casereportrdquo Archives of Gynecology and Obstetrics vol 284 no 3pp 613ndash616 2011

[4] L Domenici V Di Donato M L Gasparri F Lecce J Caccettaand P B Panici ldquoLaparotomic myomectomy in the 16th weekof pregnancy a case reportrdquo Case Reports in Obstetrics andGynecology 5 pages 2014

[5] D E Lolis S N KalantaridouGMakrydimas et al ldquoSuccessfulmyomectomy during pregnancyrdquoHuman Reproduction vol 18no 8 pp 1699ndash1702 2003

[6] S De Carolis G Fatigante S Ferrazzani et al ldquoUterinemyomectomy in pregnant womenrdquo Fetal Diagnosis and Ther-apy vol 16 no 2 pp 116ndash119 2001

[7] N Bhatla B B Dash A Kriplani and N Agarwal ldquoMyomec-tomy during pregnancy a feasible optionrdquo Journal of Obstetricsand Gynaecology Research vol 35 no 1 pp 173ndash175 2009

[8] A Cagnacci D Pirillo S Malmusi S Arangino C Alessan-drini and A Volpe ldquoEarly outcome of myomectomy by laparo-tomy minilaparotomy and laparoscopically assisted minila-parotomy A randomized prospective studyrdquoHuman Reproduc-tion vol 18 no 12 pp 2590ndash2594 2003

[9] F Parazzini S Cipriani G Bulfoni et al ldquoCentiles of weightat term birth according to maternal nationality in a northernItalian regionrdquo Italian Journal of Gynaecology and Obstetricsvol 28 no 2 pp 52ndash56 2016

[10] S P Michalas F V Oreopoulou and J S PapageorgiouldquoMyomectomy during pregnancy and caesarean sectionrdquoHuman Reproduction vol 10 no 7 pp 1869ndash1870 1995

[11] E Danzer W Holzgreve C Batukan P Miny S Tercanli and IHoesli ldquoMyomectomy during the first trimester associated withfetal limb anomalies and hydrocephalus in a twin pregnancyrdquoPrenatal Diagnosis vol 21 no 10 pp 848ndash851 2001

[12] J G Joo J Inovay M Silhavy and Z Papp ldquoSuccessfulenucleation of a necrotizing fibroid causing oligohydramniosand fetal postural deformity in the 25th week of gestation Acase reportrdquo Journal of Reproductive Medicine vol 46 no 10pp 923ndash925 2001

[13] C Celik A Acar N Cicek K Gezginc and C Akyurek ldquoCanmyomectomy be performed during pregnancyrdquo Gynecologicand Obstetric Investigation vol 53 no 2 pp 79ndash83 2002

[14] U Hasbargen A Strauss M Summerer-Moustaki et alldquoMyomectomy as a pregnancy-preserving option in the care-fully selected patientrdquo Fetal Diagnosis and Therapy vol 17 no2 pp 101ndash103 2002

[15] C Umezurike and P Feyi-Waboso ldquoSuccessful myomectomyduring pregnancy a case reportrdquo Reproductive Health vol 2no 1 2005

[16] F Usifo R Macrae R Sharma I O Opemuyi and BOnwuzurike ldquoSuccessful myomectomy in early second trimes-ter of pregnancyrdquo Journal of Obstetrics and Gynaecology vol 27no 2 pp 196ndash197 2007

[17] F S Suwandinata S E Gruessner C O Omwandho and H RTinneberg ldquoPregnancy-preserving myomectomy preliminaryreport on a new surgical techniquerdquo European Journal ofContraception and Reproductive Health Care vol 13 no 3 pp323ndash326 2008 Erratum in European Journal of Contraceptionand Reproductive Health Care vol 13 no 4 article 438 2008

[18] G K Leite H A Korkes T Viana Ade A Pitorri G Kenj andN Sass ldquoMyomectomy in the second trimester of pregnancycase reportrdquo Revista Brasileira De Ginecologia E Obstetricia vol32 no 4 pp 198ndash201 2010

[19] P Isabu J Eigbefoh F Okogbo S Okunsanya and R EifediyildquoMyomectomy during second trimester pregnancy a casereportrdquo The Nigerian Postgraduate Medical Journal vol 17 no4 pp 324ndash326 2010

[20] K Leach L Khatain and K Tocce ldquoFirst trimester myomec-tomy as an alternative to termination of pregnancy in a womanwith a symptomatic uterine leiomyoma a case reportrdquo Journalof Medical Case Reports vol 5 article 571 2011

[21] S Doerga-Bachasingh V Karsdorp G Yo R Van Der Weidenand M Van Hooff ldquoSuccessful myomectomy of a bleedingmyoma in a twin pregnancyrdquo JRSM Short Reports vol 3 no 2article 13 2012

[22] P Jhalta S G Negi andV Sharma ldquoSuccessful myomectomy inearly pregnancy for a large asymptomatic uterine myoma casereportrdquo Pan African Medical Journal vol 13 no 24 article 228Article ID 228 2016

[23] C Kosmidis G Pantos C Efthimiadis I Gkoutziomitrou EGeorgakoudi and G Anthimidis ldquoLaparoscopic excision of apedunculated uterine leiomyoma in torsion as a cause of acuteabdomen at 10 weeks of pregnancyrdquo American Journal of CaseReports vol 16 pp 505ndash508 2015

[24] C Saccardi S Visentin M Noventa E Cosmi P Litta and SGizzo ldquoUncertainties about laparoscopic myomectomy duringpregnancy a lack of evidence or an inherited misconceptionA critical literature review starting from a peculiar caserdquoMinimally Invasive Therapy and Allied Technologies vol 24 no4 pp 189ndash194 2015

[25] M Obara Y Hatakeyama and Y Shimizu ldquoVaginal myomec-tomy for semipedunculated cervical myoma during pregnancyrdquoAmerican Journal of Perinatology Reports vol 4 no 1 pp 37ndash402014

[26] A Currie E Bradley M McEwen N Al-Shabibi and P DWillson ldquoLaparoscopic approach to fibroid torsion presentingas an acute abdomen in pregnancyrdquo Journal of the Society ofLaparoendoscopic Surgeons vol 17 no 4 pp 665ndash667 2013

[27] F Kobayashi E Kondoh J Hamanishi Y Kawamura KTatsumi and I Konishi ldquoPyomayoma during pregnancy a casereport and review of the literaturerdquo Journal of Obstetrics andGynaecology Research vol 39 no 1 pp 383ndash389 2013

[28] A MacCio C Madeddu P Kotsonis et al ldquoThree cases oflaparoscopic myomectomy performed during pregnancy for


pedunculated uterine myomasrdquo Archives of Gynecology andObstetrics vol 286 no 5 pp 1209ndash1214 2012

[29] M Shafiee M Nor Azlin and D Arifuddin ldquoA successfulantenatal myomectomyrdquo Malaysian Family Physician vol 31no 7(2-3) pp 42ndash45 2012

[30] M Ardovino I Ardovino M A Castaldi A Monteverde NColacurci and L Cobellis ldquoLaparoscopic myomectomy of asubserous pedunculated fibroid at 14 weeks of pregnancy a casereportrdquo Journal of Medical Case Reports vol 5 article 545 2011

[31] A Muller Vranjes S Sijanovic D Vidosavljevic Z Kasac andK Abicic Zuljevic ldquoSurgical treatment of large smooth muscletumor of uncertain malignant potential during pregnancyrdquoMedicinski Glasnik Journal vol 8 no 2 pp 290ndash292 2011

[32] C E Son J S Choi J H Lee S W Jeon J W Bae and S SSeo ldquoA case of laparoscopic myomectomy performed duringpregnancy for subserosal uterine myomardquo Journal of Obstetricsand Gynaecology vol 31 no 2 pp 180ndash181 2011

[33] M Kasum ldquoHemoperitoneum caused by a bleeding myoma inpregnancyrdquo Acta Clinica Croatica vol 49 no 2 pp 197ndash2002010

[34] F Fanfani C Rossitto A Fagotti P Rosati V Gallotta andG Scambia ldquoLaparoscopic myomectomy at 25 weeks of preg-nancy case reportrdquo Journal of Minimally Invasive Gynecologyvol 17 no 1 pp 91ndash93 2010

[35] A S Adeyemi S E Akinola and A I Isawumi ldquoAntepartummyomectomywith a live term deliverymdasha case reportrdquoNigerianJournal of Clinical Practice vol 10 no 4 pp 346ndash348 2007

[36] J E N Okonkwo and G O Udigwe ldquoMyomectomy in preg-nancyrdquo Journal of Obstetrics and Gynaecology vol 27 no 6 pp628ndash630 2007

[37] L Dracea and D Codreanu ldquoVaginal birth after extensivemyomectomy during pregnancy in a 39-year-old nulliparouswomanrdquo Journal of Obstetrics and Gynaecology vol 26 no 4pp 374ndash375 2006

[38] L Melgrati A Damiani G Franzoni M Marziali and FSesti ldquoIsobaric (gasless) laparoscopic myomectomy duringpregnancyrdquo Journal of Minimally Invasive Gynecology vol 12no 4 pp 379ndash381 2005

[39] L Sentilhes F Sergent E Verspyck A Gravier H Roman andL Marpeau ldquoLaparoscopic myomectomy during pregnancyresulting in septic necrosis of the myometriumrdquo BJOG AnInternational Journal of Obstetrics and Gynaecology vol 110 no9 pp 876ndash878 2003

[40] J Donnez C Pirard M Smets R Polet C Feger and JSquifflet ldquoUnusual growth of a myoma during pregnancyrdquoFertility and Sterility vol 78 no 3 pp 632ndash633 2002

[41] HWilliamson ldquoEnucleation during the seventh lunarmonth ofpregnancy of a uterine fibro-myomardquo Proceedings of the RoyalSociety of Medicine vol 1 pp 73ndash78 1908

[42] J Stewart ldquoEnucleation of fibro-myoma of uterus duringpregnancyrdquo British Medical Journal vol 1 no 2358 pp 548ndash549 1906

[43] A C Wittich E R Salminen M K Yancey and G RMarkenson ldquoMyomectomy during early pregnancyrdquo MilitaryMedicine vol 165 no 2 pp 162ndash164 2000

[44] M Majid G Q Khan and L MWei ldquoInevitable myomectomyin pregnancyrdquo Journal of Obstetrics and Gynaecology vol 17 no4 pp 377ndash378 1997

[45] A C Algara A G Rodrıguez A C Vazquez et al ldquoLaparo-scopic approach for fibroid removal at 18 weeks of pregnancyrdquoSurgical Technology International vol 27 pp 195ndash197 2015

[46] C Lockyer ldquoMultiple myomectomy in the sixth month ofpregnancy labour at termrdquo Proceedings of the Royal Society ofMedicine vol 7 pp 221ndash225 1914

[47] C A von Hoffmann ldquoAbdominal myomectomy during preg-nancyrdquoCalifornia State Journal ofMedicine vol 9 no 5 pp 197ndash200 1911

[48] H R Andrews ldquoMyomectomy during pregnancyrdquo Proceedingsof the Royal Society of Medicine vol 3 pp 164ndash166 1910

[49] WC Swayne ldquoAbdominal myomectomy during pregnancyrdquoProceedings of the Royal Society of Medicine vol 1 pp 129ndash1321908

[50] A Doran ldquoMyomectomy during pregnancy and labour at termin an elderly primipara with notes on similar casesrdquo BritishMedical Journal vol 2 no 2395 pp 1446ndash1447 1906

[51] H M Evans ldquoA case of myomectomy for subperitoneal myomacomplicating pregnancyrdquo British Medical Journal vol 2 no2033 p 1673 1899

[52] C Exacoustos and P Rosati ldquoUltrasound diagnosis of uterinemyomas and complications in pregnancyrdquoObstetrics and Gyne-cology vol 82 no 1 pp 97ndash101 1993

[53] C A Burton D A Grimes and C M March ldquoSurgicalmanagement of leiomyomata during pregnancyrdquoObstetrics andGynecology vol 74 no 5 pp 707ndash709 1989

[54] R Rella E Bonfadini Bossi and D Fagnani ldquoMyomectomy inpregnancy Description of an interesting clinical caserdquoMinervaGinecologica vol 32 no 4 pp 267ndash269 1980

[55] M A Pelosi M A Pelosi III and S Giblin ldquoLaparoscopicremoval of a 1500-g symptomatic myoma during the secondtrimester of pregnancyrdquo American Association of GynecologicLaparoscopists vol 2 no 4 pp 457ndash462 1995

[56] A Pelissier-Komorek J Hamm S Bonneau E Derniaux CHoeffel-Fornes and O Graesslin ldquoMyoma and pregnancywhen medical treatment is not sufficientrdquo Journal de Gynecolo-gie Obstetrique et Biologie de la Reproduction vol 41 no 3 pp307ndash310 2012

[57] G Mollica L Pittini E Minganti G Perri and F PansinildquoElective uterine myomectomy in pregnant womenrdquo Clinicaland Experimental Obstetrics and Gynecology vol 23 no 3 pp168ndash172 1996

[58] G Febo M Tessarolo L Leo S Arduino T Wierdis and LLanza ldquoSurgical management of leiomyomata in pregnancyrdquoClinical and ExperimentalObstetrics andGynecology vol 24 no2 pp 76ndash78 1997

[59] M Bonito L Gulemı R Basili and D Roselli ldquoMyomectomyduring the first and second trimester of pregnancyrdquoClinical andExperimental Obstetrics and Gynecology vol 34 no 3 pp 149ndash150 2007

[60] E E Vazquez Camacho E Cabrera Carranco and R GSanchez Herrera ldquoPedunculated twisted myoma and preg-nancy Case reportrdquoGinecologia y Obstetricia de Mexico vol 77no 9 pp 441ndash444 2009

[61] A P Makar E A Schatteman I B Vergote and E DesmedtldquoMyomectomy during pregnancy uncommon case reportrdquoActa Chirurgica Belgica vol 89 no 4 pp 212ndash214 1989

[62] R Horno Liria ldquoMyomectomy and pregnancyrdquo Rev Esp ObstetGinecol vol 19 pp 214ndash218 1962

[63] M C Alanis A Mitra and N Koklanaris ldquoPreoperativemagnetic resonance imaging and antepartummyomectomy of agiant pedunculated leiomyomardquoObstetrics and Gynecology vol111 no 2 part 2 pp 577ndash579 2008


[64] G Ardizzone ldquoClinical and statistical considerations of 27cases of myomectomy in pregnancyrdquo Rivista di Ostetricia eGinecologia vol 10 no 12 pp 848ndash860 1955

[65] M Cozzi ldquoMyomectomy in pregnancyrdquo Quaderni di ClinicaOstetrica e Ginecologica vol 22 no 3 pp 171ndash180 1967

[66] Y Rochet M Cognat D Dargent and E Pollosson ldquoOnmyomectomy during pregnance (apropos of 14 observations)rdquoBulletin de la Federation des Societes de Gynecologie etDobstetrique de Langue Francaise vol 16 pp 462ndash463 1964

[67] F Sciannameo G Madami C Madami et al ldquoTorsion ofuterine fibroma associated with inguinal incarcerated hernia inpregnancy Case reportrdquo Minerva Ginecologica vol 48 no 11pp 501ndash504 1996

Submit your manuscripts athttpswwwhindawicom

Stem CellsInternational

Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014


MEDIATORSINFLAMMATION

of


Behavioural Neurology

EndocrinologyInternational Journal of



Disease Markers


BioMed Research International

OncologyJournal of



Oxidative Medicine and Cellular Longevity


PPAR Research

The Scientific World JournalHindawi Publishing Corporation httpwwwhindawicom Volume 2014

Immunology ResearchHindawi Publishing Corporationhttpwwwhindawicom Volume 2014

Journal of

ObesityJournal of



Computational and Mathematical Methods in Medicine

OphthalmologyJournal of


Diabetes ResearchJournal of



Research and TreatmentAIDS


Gastroenterology Research and Practice


Parkinsonrsquos Disease

Evidence-Based Complementary and Alternative Medicine

Volume 2014Hindawi Publishing Corporationhttpwwwhindawicom


Laparoscopy can be considered in selected cases such assmall subserous pedunculated myomas

There are many controversies in performing myomec-tomy during cesarean section because of the risk of hem-orrhage [3] Nevertheless the majority of indication arisesbefore labor and delivery due to acute symptoms leadingto a discussion regarding the need for intervention duringpregnancy

Therefore we present a case of successful multiple laparo-tomic myomectomy at 17 + 2 weeks of gestational age anda systematic review of the literature in order to clarifythe approach to this pathologic condition and its effect onpregnancy outcome

2 Case Report

Uterinemyomas are usually asymptomatic during pregnancyHowever pedunculated fibroids torsion may occasionallycause acute abdominal pain [1]

Most cases of laparotomic myomectomy described inliterature have been performed during a cesarean section dueto the risk of managing them surgically at low gestational age[2ndash4] We present a case of a successful multiple laparotomicmyomectomy during the second trimester of pregnancy

A 36-year-old morbidly obese primigravida presentedat our emergency room at 17 + 0 weeks of gestational agecomplaining of abdominal pain At clinical examination theuterus appeared to be of higher volume compared to thegestational age the abdomen was painful but treatable andthe obstetrical examination was normalThe patient was thenreferred to USUnit of our Department for further evaluationThe sonographic assessment revealed the presence of threesubserous uterine myomas located on anterior wall (maxi-mum diameter 132 cm) the right wall (maximum diameter126 cm) and the left wall (maximum diameter 117 cm) ofthe uterus respectively Allmyomaswere vacuolated inside asfor suspected necrosis The scan also showed other multiplemyomas less than 3 cm in size Vital signs were monitored(blood pressure 14090mmHg maternal heart rate 124 bmpSO2 94 apyretic) Amniotic fluid was normal and fetalwell-being was preserved Thus the patient was admitted tothe High-Risk-Pregnancy Unit When collecting the medicalhistory the first trimester ultrasound scan performed at 11weeksrsquo gestation revealed the presence of the same lesionswith a size of 108 cm 102 cm and 614 cm respectively

Laboratory studies demonstrated rising inflammatorymarkers (C-reactive protein 354mgLWBC 1692times 103 120583L)

Due to the persistence of the symptoms despite of twodays of analgesic antispastic and antibiotic therapy aftermultidisciplinary discussion and a thorough counseling toinform the parents of the surgical and postoperative risksconnected with uterine surgery during the gestation thepatient underwent surgery Laparotomy approach by longitu-dinal skin incision considering the volume and the positionof the myomas was performed under general anesthesiaThree huge bulky subserous pedunculated myomas were evi-denced the largest located at the uterine fundus with amaxi-mum diameter of 15 cm and a torsion of its pedicle (Figure 1)Furthermore intra-abdominal adhesions were found within

Figure 1 Myoma of the uterine fundus with evidence of torsion ofits pedicle

peritoneal cavity Blunt dissection was undertaken to free theomentum and look for the appendix which was normal Thethree large myomas evidenced by ultrasound were removedand sent for pathologic examination A pelvic drainage wasleft and removed 24 hours postoperatively Pathology showedwidespread phenomena of necrosis especially in the myomawith torsion of its pedicle

During the following nine days the patient receivedantibiotics low molecular heparin and progesterone andfetal heartbeat was checked daily Considering the improve-ment in clinical condition the patient was discharged with anindication to treatment with progesterone and lowmolecularheparin

Three weeks later at 21 weeksrsquo gestation the patientwas admitted again due to abdominal pain Obstetricalevaluation revealed cervical effacement and the transvagi-nal ultrasound scan showed a reduction of cervical length(18mm) funneling and sludge An ultrasound scan wasperformed showing good fetal variables Consequently thetherapy with progesterone was increased The patient hada positive vaginal culture for Staphylococcus haemolyticusurine culture was negative and C-reactive protein resulted tobe positiveTherefore antibiotic therapy withmacrolides wasgiven according to antibiogram result A cervical cerclagewas proposed to the patient but she refused to undergo theprocedure

Hospitalization lasted for seven days then thewomanwasdischarged due to an improvement of her clinical conditionThe patient underwent obstetric evaluation every two weeksuntil she presented in labor and delivered vaginally at 38+ 1 weeksrsquo gestation a healthy female newborn of 2940 gappropriate for gestational age according to national growthcurves [9] Apgar score was 910 at 11015840 and 51015840 respectively

3 Data Source and Literature Search

To identify potentially eligible studies we searched PubMedScopus and Cochrane Library (all from inception to 16March 2017) No language restrictions were initially appliedWe used a combination of key words and text words repre-sented by ldquomyomectomyrdquo ldquomyomardquo and ldquopregnancyrdquo

Two reviewers (Annachiara Basso and Mariana RitaCatalano) independently screened the titles and abstracts of






63 studies included


Iden

tica

tion

Scre

enin

gEl

igib

ility

Inclu

sion



4 Results



5 Discussion





6 Conclusion


Disclosure



Table1Ch

aracteris

ticso

fthe

relevant

studies

Reference

Num

bero

fpatie

nts

Gestatio

nalage

atdiagno

sis(w

eeks)

Gestatio

nalage

atmyomectomy

(weeks)

Type

ofsurgery

Fibroidmaxim

umvolume(cm

)Mod

eofd

elivery

Gestatio

nalage

atdelivery

Neonatal

outcom

e(Apgar

birthw

eightpH

)

DeC

arolisetal

2001

18

nd13

LPT

8CS

39883150

gnd

23LP

T40

CS38

882670

gnd

19LP

T14

VD

36893080

gnd

17LP

T21

CS38

893060

gnd

19LP

T15

Fetald

emise

at19

weeks

nd20

LPT

6VD

41992970

gnd

19LP

T12

CS39

793180

gnd

8LP

T9

CS40

993300

gnd

12LP

T8

CS38

9102780g

nd17

LPT

24CS

38993900

gnd

15LP

T10

CS40

8103170g

nd17

LPT

13CS

399103100g

nd6

LPT

15nd

ndnd

nd20

LPT

8CS

399102860g

nd10

LPT

16CS

409103500g

nd16

LPT

10CS

399103930g

nd13

LPT

14CS

39993180

gnd

7LP

T15

CS38

910

-2550g

Dom

enicietal

2014

116

16LP

T20

CS38

89-3

250g

Michalase

tal

1995

114

15LP

T20

CS39

2800

g

Danzere

tal2001

112

12LP

T10

CS37

9103235g

9102810g

Lozzae

tal2011

112

16LP

T18

CS36

992280

gJooetal2001

18

25LP

T12

CS40

3600

g

Celik

etal2002

5

nd22

LPT

13CS

386+minus11

103200g

nd18

LPT

10CS

386+minus11

93400

gnd

20LP

T12

CS386+minus11

10360

0gnd

16LP

T15

CS386+minus11

83100

gnd

13LP

T20

CS386+minus11

92800

gHasbargen

etal

2002

118

18LP

T15

CS36

892495

g

Umezurikea

ndFeyi-W

aboso2005

119

19LP

T32

VD

388103500g

Usifoetal2007

113

13LP

T17

CS38

3990

gSuwandinataetal

2009

1nd

18LP

Tnd

CS37

892950

g


Table1Con

tinued

Reference

Num

bero

fpatie

nts

Gestatio

nalage

atdiagno

sis(w

eeks)

Gestatio

nalage

atmyomectomy

(weeks)

Type

ofsurgery

Fibroidmaxim

umvolume(cm

)Mod

eofd

elivery

Gestatio

nalage

atdelivery

Neonatal

outcom

e(Apgar

birthw

eightpH

)Bh

atlaetal2009

18

19LP

T28

VD

382740

gLeite

etal2009

11sttrim

ester

17LP

T10

CS39

9103315g

Isabuetal2010

114

14LP

Tnd

CS37

2700

gLeachetal2011

111

11LP

T14

CS40

994356

gDoerga-

Bachasingh

etal

2012

19

10LP

T15

CS37

nd

Jhaltaetal2016

113

13LP

T16

VD

39810300

0gKo

smidisetal

2015

110

10LP

S8

ndnd

nd

Saccardi

etal2015

19

15LP

S24

CS41

4460

g72

Obara

etal2014

16

13VA

G6

VD

402775

gCu

rrieetal2013

111

11LP

S8

ndnd

ndKo

bayashietal

2013

121

21LP

T8

CS37

2730

g

MacCioetal2012

38

19LP

S11

CS39

3150

g20

20LP

S10

VD

403310g

2020

LPS

ndCS

393050

gShafiee

etal2012

115

21LP

S15

CS38

ndArdovinoetal

2011

114

14LP

S6

VD

403216g

MullerV

ranjes

etal

114

18LP

T35

CS33

1010

1750g

728

Sonetal2011

118

18LP

S9

VD

393740

gKa

sum

2010

115

15LP

T9

VD

38nd

Fanfanietal2010

125

25LP

S9

VD

402950

gAd

eyem

ietal

2007

119

19LP

T30

VD

397103500g

Okonk

woand

Udigw

e2007

119

24LP

Tnd

CSnd

nd

Draceaa

ndCod

reanu2006

112

13LP

T24

VD

ndnd

Melgratietal2005

124

24LP

S7

VD

3999


ble1Con

tinued

Reference

Num

bero

fpatie

nts

Gestatio

nalage

atdiagno

sis(w

eeks)

Gestatio

nalage

atmyomectomy

(weeks)

Type

ofsurgery

Fibroidmaxim

umvolume(cm

)Mod

eofd

elivery

Gestatio

nalage

atdelivery

Neonatal

outcom

e(Apgar

birthw

eightpH

)Sentilh

esetal

2003

117

17LP

S5

CS37

3530

g

Lolis

etal2003

13

nd16

LPT

ndCS

373340

gnd

15LP

Tnd

CS39

3600

gnd

19LP

Tnd

CS37

2970

gnd

16LP

Tnd

CS36

3000

gnd

15LP

Tnd

Fetald

emise

at15

weeks

nd15

LPT

ndCS

372740

gnd

16LP

Tnd

CS38

3180

gnd

16LP

Tnd

CS39

3515g

nd16

LPT

ndCS

393190

gnd

19LP

Tnd

CS38

2920

gnd

17LP

Tnd

CS38

3520

gnd

16LP

Tnd

CS38

3000

gnd

15LP

Tnd

CS29

1606

g

Don

neze

tal2002

1Be

fore

pregnancy

25LP

T22

CS35

2280

g

Williamson

1908

122

22LP

T32

VD

23Neonatald

eath

Stew

art1906

120

20LP

T24

VD

40nd

Wittichetal2000

112

15LP

T20

CS37

993275

gMajid

etal1997

117

18LP

T24

Fetald

emise

19weeks

Algarae

tal2015

118

18LP

S7

VD

24nd

Lockyer1914

121

21LP

Tnd

VD

402300

g

vonHoff

mann1911

316

16LP

Tnd

VD

403630

g22

25LP

Tnd

Fetald

emise

at25

weeks

1415

LPT

ndVD

40nd

And

rews1910

1Be

fore

pregnancy

9LP

Tnd

VD

40nd

Swayne1908

220

20LP

Tnd

ndnd

nd16

16LP

Tnd

VD

24nd

Doran1906

120

21LP

T10

VD

40nd

Evans1899

120

20LP

T7

ndnd

ndEx

acou

stosa

ndRo

sati

1993

13nd

lt26

ndnd

NG

40(8)pretermgt

32(5)

nd

Burton

etal1989

8

nd13

LPT

18VD

40nd

nd15

LPT

14Fetald

emise

15weeks

ndnd

LPT

5VD

40nd

ndnd

LPT

5VD

40nd

ndnd

LPT

5VD

40nd

ndnd

LPT

5VD

40nd

ndnd

LPT

5VD

40nd

ndnd

LPT

5nd

ndnd

Rella

etal1980

110

12LP

Tnd

VD

27Neonatald

eath


ble1Con

tinued

Reference

Num

bero

fpatie

nts

Gestatio

nalage

atdiagno

sis(w

eeks)

Gestatio

nalage

atmyomectomy

(weeks)

Type

ofsurgery

Fibroidmaxim

umvolume(cm

)Mod

eofd

elivery

Gestatio

nalage

atdelivery

Neonatal

outcom

e(Apgar

birthw

eightpH

)Pelosietal1995

113

15LP

S6

CS39

ndPelissie

r-Ko

morek

etal2012

110

13LP

T22

VD

352280

g

Mollicae

tal1996

188ndash17

10ndash19

LPT

gt10

CS(17)V

D(1)

ndgt7(18)gt

2500

g(17)lt

2500

g(1)

Febo

etal1997

3nd

12ndash19

LPT

NG

CS(2)abortio

n(1)

37-38

nd

Bonito

etal2007

5nd

9ndash15

LPT

35ndash145

CS(2)VD(3)

382

9+minus083

3200ndash4

072g

Vazqu

ezCa

macho

etal2009

17

16LP

T62

VD

4099

Makar

etal1989

112

17LP

T13500

gCS

38993950

gHorno

Liria

1962

116

16LP

Tnd

VD

403600

gAlanise

tal2008

17

12LP

T30

VD

382330

g

Ardizzone1955

27

88

LPT

ndnd

ndnd

88

LPT

ndnd

ndnd

88

LPT

ndMisc

arria

geat9weeks

2424

LPT

ndFetald

emise

at25

weeks

88

LPT

ndMisc

arria

geat8weeks

1616

LPT

ndnd

ndnd

88

LPT

ndnd

ndnd

88

LPT

ndnd

ndnd

1212

LPT

ndFetald

emise

at14

weeks

2020

LPT

ndnd

ndnd

1616

LPT

ndnd

ndnd

2020

LPT

ndnd

ndnd

2020

LPT

ndnd

ndnd

1212

LPT

ndnd

ndnd

1212

LPT

ndFetald

emise

at13

weeks

88

LPT

ndnd

ndnd

88

LPT

ndnd

ndnd

1212

LPT

ndFetald

emise

at13

weeks

1212

LPT

ndnd

ndnd

1616

LPT

ndFetald

emise

at17

weeks

88

LPT

ndnd

ndnd

1212

LPT

ndnd

ndnd

1212

LPT

ndnd

ndnd

1212

LPT

ndnd

ndnd

88

LPT

ndnd

ndnd

1212

LPT

ndFetald

emise

at12

weeks

1212

LPT

ndnd

ndnd


Table1Con

tinued

Reference

Num

bero

fpatie

nts

Gestatio

nalage

atdiagno

sis(w

eeks)

Gestatio

nalage

atmyomectomy

(weeks)

Type

ofsurgery

Fibroidmaxim

umvolume(cm

)Mod

eofd

elivery

Gestatio

nalage

atdelivery

Neonatal

outcom

e(Apgar

birthw

eightpH

)

Cozzi1967

16

nd12

LPT

ndVD

40nd

nd12

LPT

ndVD

40nd

nd8

LPT

ndVD

40nd

nd8

LPT

ndVD

40nd

nd16

LPT

ndVD

38nd

nd8

LPT

ndVD

40nd

nd12

LPT

ndVD

38nd

nd8

LPT

ndVD

40nd

nd16

LPT

ndVD

40nd

nd20

LPT

ndVD

36nd

nd8

LPT

ndVD

40nd

nd12

LPT

ndVD

40nd

nd12

LPT

ndVD

40nd

nd12

LPT

ndVD

40nd

nd16

LPT

ndVD

40nd

nd8

LPT

ndVD

40nd

Rochetetal1964

14nd

ndLP

T10

ndnd

ndSciann

ameo

etal

1996

120

20LP

T4

ndnd

nd

ndnot

determ

inedC

Scesarean

section

VDvaginaldeliveryLP

TlaparotomyLP

Slap

aroscopyV

AGvaginalsurgery





References












































































of






Disease Markers



OncologyJournal of





PPAR Research



Journal of

ObesityJournal of





















63 studies included


Iden

tica

tion

Scre

enin

gEl

igib

ility

Inclu

sion



4 Results



5 Discussion





6 Conclusion


Disclosure



Table1Ch

aracteris

ticso

fthe

relevant

studies

Reference

Num

bero

fpatie

nts

Gestatio

nalage

atdiagno

sis(w

eeks)

Gestatio

nalage

atmyomectomy

(weeks)

Type

ofsurgery

Fibroidmaxim

umvolume(cm

)Mod

eofd

elivery

Gestatio

nalage

atdelivery

Neonatal

outcom

e(Apgar

birthw

eightpH

)

DeC

arolisetal

2001

18

nd13

LPT

8CS

39883150

gnd

23LP

T40

CS38

882670

gnd

19LP

T14

VD

36893080

gnd

17LP

T21

CS38

893060

gnd

19LP

T15

Fetald

emise

at19

weeks

nd20

LPT

6VD

41992970

gnd

19LP

T12

CS39

793180

gnd

8LP

T9

CS40

993300

gnd

12LP

T8

CS38

9102780g

nd17

LPT

24CS

38993900

gnd

15LP

T10

CS40

8103170g

nd17

LPT

13CS

399103100g

nd6

LPT

15nd

ndnd

nd20

LPT

8CS

399102860g

nd10

LPT

16CS

409103500g

nd16

LPT

10CS

399103930g

nd13

LPT

14CS

39993180

gnd

7LP

T15

CS38

910

-2550g

Dom

enicietal

2014

116

16LP

T20

CS38

89-3

250g

Michalase

tal

1995

114

15LP

T20

CS39

2800

g

Danzere

tal2001

112

12LP

T10

CS37

9103235g

9102810g

Lozzae

tal2011

112

16LP

T18

CS36

992280

gJooetal2001

18

25LP

T12

CS40

3600

g

Celik

etal2002

5

nd22

LPT

13CS

386+minus11

103200g

nd18

LPT

10CS

386+minus11

93400

gnd

20LP

T12

CS386+minus11

10360

0gnd

16LP

T15

CS386+minus11

83100

gnd

13LP

T20

CS386+minus11

92800

gHasbargen

etal

2002

118

18LP

T15

CS36

892495

g

Umezurikea

ndFeyi-W

aboso2005

119

19LP

T32

VD

388103500g

Usifoetal2007

113

13LP

T17

CS38

3990

gSuwandinataetal

2009

1nd

18LP

Tnd

CS37

892950

g


Table1Con

tinued

Reference

Num

bero

fpatie

nts

Gestatio

nalage

atdiagno

sis(w

eeks)

Gestatio

nalage

atmyomectomy

(weeks)

Type

ofsurgery

Fibroidmaxim

umvolume(cm

)Mod

eofd

elivery

Gestatio

nalage

atdelivery

Neonatal

outcom

e(Apgar

birthw

eightpH

)Bh

atlaetal2009

18

19LP

T28

VD

382740

gLeite

etal2009

11sttrim

ester

17LP

T10

CS39

9103315g

Isabuetal2010

114

14LP

Tnd

CS37

2700

gLeachetal2011

111

11LP

T14

CS40

994356

gDoerga-

Bachasingh

etal

2012

19

10LP

T15

CS37

nd

Jhaltaetal2016

113

13LP

T16

VD

39810300

0gKo

smidisetal

2015

110

10LP

S8

ndnd

nd

Saccardi

etal2015

19

15LP

S24

CS41

4460

g72

Obara

etal2014

16

13VA

G6

VD

402775

gCu

rrieetal2013

111

11LP

S8

ndnd

ndKo

bayashietal

2013

121

21LP

T8

CS37

2730

g

MacCioetal2012

38

19LP

S11

CS39

3150

g20

20LP

S10

VD

403310g

2020

LPS

ndCS

393050

gShafiee

etal2012

115

21LP

S15

CS38

ndArdovinoetal

2011

114

14LP

S6

VD

403216g

MullerV

ranjes

etal

114

18LP

T35

CS33

1010

1750g

728

Sonetal2011

118

18LP

S9

VD

393740

gKa

sum

2010

115

15LP

T9

VD

38nd

Fanfanietal2010

125

25LP

S9

VD

402950

gAd

eyem

ietal

2007

119

19LP

T30

VD

397103500g

Okonk

woand

Udigw

e2007

119

24LP

Tnd

CSnd

nd

Draceaa

ndCod

reanu2006

112

13LP

T24

VD

ndnd

Melgratietal2005

124

24LP

S7

VD

3999


ble1Con

tinued

Reference

Num

bero

fpatie

nts

Gestatio

nalage

atdiagno

sis(w

eeks)

Gestatio

nalage

atmyomectomy

(weeks)

Type

ofsurgery

Fibroidmaxim

umvolume(cm

)Mod

eofd

elivery

Gestatio

nalage

atdelivery

Neonatal

outcom

e(Apgar

birthw

eightpH

)Sentilh

esetal

2003

117

17LP

S5

CS37

3530

g

Lolis

etal2003

13

nd16

LPT

ndCS

373340

gnd

15LP

Tnd

CS39

3600

gnd

19LP

Tnd

CS37

2970

gnd

16LP

Tnd

CS36

3000

gnd

15LP

Tnd

Fetald

emise

at15

weeks

nd15

LPT

ndCS

372740

gnd

16LP

Tnd

CS38

3180

gnd

16LP

Tnd

CS39

3515g

nd16

LPT

ndCS

393190

gnd

19LP

Tnd

CS38

2920

gnd

17LP

Tnd

CS38

3520

gnd

16LP

Tnd

CS38

3000

gnd

15LP

Tnd

CS29

1606

g

Don

neze

tal2002

1Be

fore

pregnancy

25LP

T22

CS35

2280

g

Williamson

1908

122

22LP

T32

VD

23Neonatald

eath

Stew

art1906

120

20LP

T24

VD

40nd

Wittichetal2000

112

15LP

T20

CS37

993275

gMajid

etal1997

117

18LP

T24

Fetald

emise

19weeks

Algarae

tal2015

118

18LP

S7

VD

24nd

Lockyer1914

121

21LP

Tnd

VD

402300

g

vonHoff

mann1911

316

16LP

Tnd

VD

403630

g22

25LP

Tnd

Fetald

emise

at25

weeks

1415

LPT

ndVD

40nd

And

rews1910

1Be

fore

pregnancy

9LP

Tnd

VD

40nd

Swayne1908

220

20LP

Tnd

ndnd

nd16

16LP

Tnd

VD

24nd

Doran1906

120

21LP

T10

VD

40nd

Evans1899

120

20LP

T7

ndnd

ndEx

acou

stosa

ndRo

sati

1993

13nd

lt26

ndnd

NG

40(8)pretermgt

32(5)

nd

Burton

etal1989

8

nd13

LPT

18VD

40nd

nd15

LPT

14Fetald

emise

15weeks

ndnd

LPT

5VD

40nd

ndnd

LPT

5VD

40nd

ndnd

LPT

5VD

40nd

ndnd

LPT

5VD

40nd

ndnd

LPT

5VD

40nd

ndnd

LPT

5nd

ndnd

Rella

etal1980

110

12LP

Tnd

VD

27Neonatald

eath


ble1Con

tinued

Reference

Num

bero

fpatie

nts

Gestatio

nalage

atdiagno

sis(w

eeks)

Gestatio

nalage

atmyomectomy

(weeks)

Type

ofsurgery

Fibroidmaxim

umvolume(cm

)Mod

eofd

elivery

Gestatio

nalage

atdelivery

Neonatal

outcom

e(Apgar

birthw

eightpH

)Pelosietal1995

113

15LP

S6

CS39

ndPelissie

r-Ko

morek

etal2012

110

13LP

T22

VD

352280

g

Mollicae

tal1996

188ndash17

10ndash19

LPT

gt10

CS(17)V

D(1)

ndgt7(18)gt

2500

g(17)lt

2500

g(1)

Febo

etal1997

3nd

12ndash19

LPT

NG

CS(2)abortio

n(1)

37-38

nd

Bonito

etal2007

5nd

9ndash15

LPT

35ndash145

CS(2)VD(3)

382

9+minus083

3200ndash4

072g

Vazqu

ezCa

macho

etal2009

17

16LP

T62

VD

4099

Makar

etal1989

112

17LP

T13500

gCS

38993950

gHorno

Liria

1962

116

16LP

Tnd

VD

403600

gAlanise

tal2008

17

12LP

T30

VD

382330

g

Ardizzone1955

27

88

LPT

ndnd

ndnd

88

LPT

ndnd

ndnd

88

LPT

ndMisc

arria

geat9weeks

2424

LPT

ndFetald

emise

at25

weeks

88

LPT

ndMisc

arria

geat8weeks

1616

LPT

ndnd

ndnd

88

LPT

ndnd

ndnd

88

LPT

ndnd

ndnd

1212

LPT

ndFetald

emise

at14

weeks

2020

LPT

ndnd

ndnd

1616

LPT

ndnd

ndnd

2020

LPT

ndnd

ndnd

2020

LPT

ndnd

ndnd

1212

LPT

ndnd

ndnd

1212

LPT

ndFetald

emise

at13

weeks

88

LPT

ndnd

ndnd

88

LPT

ndnd

ndnd

1212

LPT

ndFetald

emise

at13

weeks

1212

LPT

ndnd

ndnd

1616

LPT

ndFetald

emise

at17

weeks

88

LPT

ndnd

ndnd

1212

LPT

ndnd

ndnd

1212

LPT

ndnd

ndnd

1212

LPT

ndnd

ndnd

88

LPT

ndnd

ndnd

1212

LPT

ndFetald

emise

at12

weeks

1212

LPT

ndnd

ndnd


Table1Con

tinued

Reference

Num

bero

fpatie

nts

Gestatio

nalage

atdiagno

sis(w

eeks)

Gestatio

nalage

atmyomectomy

(weeks)

Type

ofsurgery

Fibroidmaxim

umvolume(cm

)Mod

eofd

elivery

Gestatio

nalage

atdelivery

Neonatal

outcom

e(Apgar

birthw

eightpH

)

Cozzi1967

16

nd12

LPT

ndVD

40nd

nd12

LPT

ndVD

40nd

nd8

LPT

ndVD

40nd

nd8

LPT

ndVD

40nd

nd16

LPT

ndVD

38nd

nd8

LPT

ndVD

40nd

nd12

LPT

ndVD

38nd

nd8

LPT

ndVD

40nd

nd16

LPT

ndVD

40nd

nd20

LPT

ndVD

36nd

nd8

LPT

ndVD

40nd

nd12

LPT

ndVD

40nd

nd12

LPT

ndVD

40nd

nd12

LPT

ndVD

40nd

nd16

LPT

ndVD

40nd

nd8

LPT

ndVD

40nd

Rochetetal1964

14nd

ndLP

T10

ndnd

ndSciann

ameo

etal

1996

120

20LP

T4

ndnd

nd

ndnot

determ

inedC

Scesarean

section

VDvaginaldeliveryLP

TlaparotomyLP

Slap

aroscopyV

AGvaginalsurgery





References












































































of






Disease Markers



OncologyJournal of





PPAR Research



Journal of

ObesityJournal of

















Table1Ch

aracteris

ticso

fthe

relevant

studies

Reference

Num

bero

fpatie

nts

Gestatio

nalage

atdiagno

sis(w

eeks)

Gestatio

nalage

atmyomectomy

(weeks)

Type

ofsurgery

Fibroidmaxim

umvolume(cm

)Mod

eofd

elivery

Gestatio

nalage

atdelivery

Neonatal

outcom

e(Apgar

birthw

eightpH

)

DeC

arolisetal

2001

18

nd13

LPT

8CS

39883150

gnd

23LP

T40

CS38

882670

gnd

19LP

T14

VD

36893080

gnd

17LP

T21

CS38

893060

gnd

19LP

T15

Fetald

emise

at19

weeks

nd20

LPT

6VD

41992970

gnd

19LP

T12

CS39

793180

gnd

8LP

T9

CS40

993300

gnd

12LP

T8

CS38

9102780g

nd17

LPT

24CS

38993900

gnd

15LP

T10

CS40

8103170g

nd17

LPT

13CS

399103100g

nd6

LPT

15nd

ndnd

nd20

LPT

8CS

399102860g

nd10

LPT

16CS

409103500g

nd16

LPT

10CS

399103930g

nd13

LPT

14CS

39993180

gnd

7LP

T15

CS38

910

-2550g

Dom

enicietal

2014

116

16LP

T20

CS38

89-3

250g

Michalase

tal

1995

114

15LP

T20

CS39

2800

g

Danzere

tal2001

112

12LP

T10

CS37

9103235g

9102810g

Lozzae

tal2011

112

16LP

T18

CS36

992280

gJooetal2001

18

25LP

T12

CS40

3600

g

Celik

etal2002

5

nd22

LPT

13CS

386+minus11

103200g

nd18

LPT

10CS

386+minus11

93400

gnd

20LP

T12

CS386+minus11

10360

0gnd

16LP

T15

CS386+minus11

83100

gnd

13LP

T20

CS386+minus11

92800

gHasbargen

etal

2002

118

18LP

T15

CS36

892495

g

Umezurikea

ndFeyi-W

aboso2005

119

19LP

T32

VD

388103500g

Usifoetal2007

113

13LP

T17

CS38

3990

gSuwandinataetal

2009

1nd

18LP

Tnd

CS37

892950

g


Table1Con

tinued

Reference

Num

bero

fpatie

nts

Gestatio

nalage

atdiagno

sis(w

eeks)

Gestatio

nalage

atmyomectomy

(weeks)

Type

ofsurgery

Fibroidmaxim

umvolume(cm

)Mod

eofd

elivery

Gestatio

nalage

atdelivery

Neonatal

outcom

e(Apgar

birthw

eightpH

)Bh

atlaetal2009

18

19LP

T28

VD

382740

gLeite

etal2009

11sttrim

ester

17LP

T10

CS39

9103315g

Isabuetal2010

114

14LP

Tnd

CS37

2700

gLeachetal2011

111

11LP

T14

CS40

994356

gDoerga-

Bachasingh

etal

2012

19

10LP

T15

CS37

nd

Jhaltaetal2016

113

13LP

T16

VD

39810300

0gKo

smidisetal

2015

110

10LP

S8

ndnd

nd

Saccardi

etal2015

19

15LP

S24

CS41

4460

g72

Obara

etal2014

16

13VA

G6

VD

402775

gCu

rrieetal2013

111

11LP

S8

ndnd

ndKo

bayashietal

2013

121

21LP

T8

CS37

2730

g

MacCioetal2012

38

19LP

S11

CS39

3150

g20

20LP

S10

VD

403310g

2020

LPS

ndCS

393050

gShafiee

etal2012

115

21LP

S15

CS38

ndArdovinoetal

2011

114

14LP

S6

VD

403216g

MullerV

ranjes

etal

114

18LP

T35

CS33

1010

1750g

728

Sonetal2011

118

18LP

S9

VD

393740

gKa

sum

2010

115

15LP

T9

VD

38nd

Fanfanietal2010

125

25LP

S9

VD

402950

gAd

eyem

ietal

2007

119

19LP

T30

VD

397103500g

Okonk

woand

Udigw

e2007

119

24LP

Tnd

CSnd

nd

Draceaa

ndCod

reanu2006

112

13LP

T24

VD

ndnd

Melgratietal2005

124

24LP

S7

VD

3999


ble1Con

tinued

Reference

Num

bero

fpatie

nts

Gestatio

nalage

atdiagno

sis(w

eeks)

Gestatio

nalage

atmyomectomy

(weeks)

Type

ofsurgery

Fibroidmaxim

umvolume(cm

)Mod

eofd

elivery

Gestatio

nalage

atdelivery

Neonatal

outcom

e(Apgar

birthw

eightpH

)Sentilh

esetal

2003

117

17LP

S5

CS37

3530

g

Lolis

etal2003

13

nd16

LPT

ndCS

373340

gnd

15LP

Tnd

CS39

3600

gnd

19LP

Tnd

CS37

2970

gnd

16LP

Tnd

CS36

3000

gnd

15LP

Tnd

Fetald

emise

at15

weeks

nd15

LPT

ndCS

372740

gnd

16LP

Tnd

CS38

3180

gnd

16LP

Tnd

CS39

3515g

nd16

LPT

ndCS

393190

gnd

19LP

Tnd

CS38

2920

gnd

17LP

Tnd

CS38

3520

gnd

16LP

Tnd

CS38

3000

gnd

15LP

Tnd

CS29

1606

g

Don

neze

tal2002

1Be

fore

pregnancy

25LP

T22

CS35

2280

g

Williamson

1908

122

22LP

T32

VD

23Neonatald

eath

Stew

art1906

120

20LP

T24

VD

40nd

Wittichetal2000

112

15LP

T20

CS37

993275

gMajid

etal1997

117

18LP

T24

Fetald

emise

19weeks

Algarae

tal2015

118

18LP

S7

VD

24nd

Lockyer1914

121

21LP

Tnd

VD

402300

g

vonHoff

mann1911

316

16LP

Tnd

VD

403630

g22

25LP

Tnd

Fetald

emise

at25

weeks

1415

LPT

ndVD

40nd

And

rews1910

1Be

fore

pregnancy

9LP

Tnd

VD

40nd

Swayne1908

220

20LP

Tnd

ndnd

nd16

16LP

Tnd

VD

24nd

Doran1906

120

21LP

T10

VD

40nd

Evans1899

120

20LP

T7

ndnd

ndEx

acou

stosa

ndRo

sati

1993

13nd

lt26

ndnd

NG

40(8)pretermgt

32(5)

nd

Burton

etal1989

8

nd13

LPT

18VD

40nd

nd15

LPT

14Fetald

emise

15weeks

ndnd

LPT

5VD

40nd

ndnd

LPT

5VD

40nd

ndnd

LPT

5VD

40nd

ndnd

LPT

5VD

40nd

ndnd

LPT

5VD

40nd

ndnd

LPT

5nd

ndnd

Rella

etal1980

110

12LP

Tnd

VD

27Neonatald

eath


ble1Con

tinued

Reference

Num

bero

fpatie

nts

Gestatio

nalage

atdiagno

sis(w

eeks)

Gestatio

nalage

atmyomectomy

(weeks)

Type

ofsurgery

Fibroidmaxim

umvolume(cm

)Mod

eofd

elivery

Gestatio

nalage

atdelivery

Neonatal

outcom

e(Apgar

birthw

eightpH

)Pelosietal1995

113

15LP

S6

CS39

ndPelissie

r-Ko

morek

etal2012

110

13LP

T22

VD

352280

g

Mollicae

tal1996

188ndash17

10ndash19

LPT

gt10

CS(17)V

D(1)

ndgt7(18)gt

2500

g(17)lt

2500

g(1)

Febo

etal1997

3nd

12ndash19

LPT

NG

CS(2)abortio

n(1)

37-38

nd

Bonito

etal2007

5nd

9ndash15

LPT

35ndash145

CS(2)VD(3)

382

9+minus083

3200ndash4

072g

Vazqu

ezCa

macho

etal2009

17

16LP

T62

VD

4099

Makar

etal1989

112

17LP

T13500

gCS

38993950

gHorno

Liria

1962

116

16LP

Tnd

VD

403600

gAlanise

tal2008

17

12LP

T30

VD

382330

g

Ardizzone1955

27

88

LPT

ndnd

ndnd

88

LPT

ndnd

ndnd

88

LPT

ndMisc

arria

geat9weeks

2424

LPT

ndFetald

emise

at25

weeks

88

LPT

ndMisc

arria

geat8weeks

1616

LPT

ndnd

ndnd

88

LPT

ndnd

ndnd

88

LPT

ndnd

ndnd

1212

LPT

ndFetald

emise

at14

weeks

2020

LPT

ndnd

ndnd

1616

LPT

ndnd

ndnd

2020

LPT

ndnd

ndnd

2020

LPT

ndnd

ndnd

1212

LPT

ndnd

ndnd

1212

LPT

ndFetald

emise

at13

weeks

88

LPT

ndnd

ndnd

88

LPT

ndnd

ndnd

1212

LPT

ndFetald

emise

at13

weeks

1212

LPT

ndnd

ndnd

1616

LPT

ndFetald

emise

at17

weeks

88

LPT

ndnd

ndnd

1212

LPT

ndnd

ndnd

1212

LPT

ndnd

ndnd

1212

LPT

ndnd

ndnd

88

LPT

ndnd

ndnd

1212

LPT

ndFetald

emise

at12

weeks

1212

LPT

ndnd

ndnd


Table1Con

tinued

Reference

Num

bero

fpatie

nts

Gestatio

nalage

atdiagno

sis(w

eeks)

Gestatio

nalage

atmyomectomy

(weeks)

Type

ofsurgery

Fibroidmaxim

umvolume(cm

)Mod

eofd

elivery

Gestatio

nalage

atdelivery

Neonatal

outcom

e(Apgar

birthw

eightpH

)

Cozzi1967

16

nd12

LPT

ndVD

40nd

nd12

LPT

ndVD

40nd

nd8

LPT

ndVD

40nd

nd8

LPT

ndVD

40nd

nd16

LPT

ndVD

38nd

nd8

LPT

ndVD

40nd

nd12

LPT

ndVD

38nd

nd8

LPT

ndVD

40nd

nd16

LPT

ndVD

40nd

nd20

LPT

ndVD

36nd

nd8

LPT

ndVD

40nd

nd12

LPT

ndVD

40nd

nd12

LPT

ndVD

40nd

nd12

LPT

ndVD

40nd

nd16

LPT

ndVD

40nd

nd8

LPT

ndVD

40nd

Rochetetal1964

14nd

ndLP

T10

ndnd

ndSciann

ameo

etal

1996

120

20LP

T4

ndnd

nd

ndnot

determ

inedC

Scesarean

section

VDvaginaldeliveryLP

TlaparotomyLP

Slap

aroscopyV

AGvaginalsurgery





References












































































of






Disease Markers



OncologyJournal of





PPAR Research



Journal of

ObesityJournal of

















Table1Con

tinued

Reference

Num

bero

fpatie

nts

Gestatio

nalage

atdiagno

sis(w

eeks)

Gestatio

nalage

atmyomectomy

(weeks)

Type

ofsurgery

Fibroidmaxim

umvolume(cm

)Mod

eofd

elivery

Gestatio

nalage

atdelivery

Neonatal

outcom

e(Apgar

birthw

eightpH

)Bh

atlaetal2009

18

19LP

T28

VD

382740

gLeite

etal2009

11sttrim

ester

17LP

T10

CS39

9103315g

Isabuetal2010

114

14LP

Tnd

CS37

2700

gLeachetal2011

111

11LP

T14

CS40

994356

gDoerga-

Bachasingh

etal

2012

19

10LP

T15

CS37

nd

Jhaltaetal2016

113

13LP

T16

VD

39810300

0gKo

smidisetal

2015

110

10LP

S8

ndnd

nd

Saccardi

etal2015

19

15LP

S24

CS41

4460

g72

Obara

etal2014

16

13VA

G6

VD

402775

gCu

rrieetal2013

111

11LP

S8

ndnd

ndKo

bayashietal

2013

121

21LP

T8

CS37

2730

g

MacCioetal2012

38

19LP

S11

CS39

3150

g20

20LP

S10

VD

403310g

2020

LPS

ndCS

393050

gShafiee

etal2012

115

21LP

S15

CS38

ndArdovinoetal

2011

114

14LP

S6

VD

403216g

MullerV

ranjes

etal

114

18LP

T35

CS33

1010

1750g

728

Sonetal2011

118

18LP

S9

VD

393740

gKa

sum

2010

115

15LP

T9

VD

38nd

Fanfanietal2010

125

25LP

S9

VD

402950

gAd

eyem

ietal

2007

119

19LP

T30

VD

397103500g

Okonk

woand

Udigw

e2007

119

24LP

Tnd

CSnd

nd

Draceaa

ndCod

reanu2006

112

13LP

T24

VD

ndnd

Melgratietal2005

124

24LP

S7

VD

3999


ble1Con

tinued

Reference

Num

bero

fpatie

nts

Gestatio

nalage

atdiagno

sis(w

eeks)

Gestatio

nalage

atmyomectomy

(weeks)

Type

ofsurgery

Fibroidmaxim

umvolume(cm

)Mod

eofd

elivery

Gestatio

nalage

atdelivery

Neonatal

outcom

e(Apgar

birthw

eightpH

)Sentilh

esetal

2003

117

17LP

S5

CS37

3530

g

Lolis

etal2003

13

nd16

LPT

ndCS

373340

gnd

15LP

Tnd

CS39

3600

gnd

19LP

Tnd

CS37

2970

gnd

16LP

Tnd

CS36

3000

gnd

15LP

Tnd

Fetald

emise

at15

weeks

nd15

LPT

ndCS

372740

gnd

16LP

Tnd

CS38

3180

gnd

16LP

Tnd

CS39

3515g

nd16

LPT

ndCS

393190

gnd

19LP

Tnd

CS38

2920

gnd

17LP

Tnd

CS38

3520

gnd

16LP

Tnd

CS38

3000

gnd

15LP

Tnd

CS29

1606

g

Don

neze

tal2002

1Be

fore

pregnancy

25LP

T22

CS35

2280

g

Williamson

1908

122

22LP

T32

VD

23Neonatald

eath

Stew

art1906

120

20LP

T24

VD

40nd

Wittichetal2000

112

15LP

T20

CS37

993275

gMajid

etal1997

117

18LP

T24

Fetald

emise

19weeks

Algarae

tal2015

118

18LP

S7

VD

24nd

Lockyer1914

121

21LP

Tnd

VD

402300

g

vonHoff

mann1911

316

16LP

Tnd

VD

403630

g22

25LP

Tnd

Fetald

emise

at25

weeks

1415

LPT

ndVD

40nd

And

rews1910

1Be

fore

pregnancy

9LP

Tnd

VD

40nd

Swayne1908

220

20LP

Tnd

ndnd

nd16

16LP

Tnd

VD

24nd

Doran1906

120

21LP

T10

VD

40nd

Evans1899

120

20LP

T7

ndnd

ndEx

acou

stosa

ndRo

sati

1993

13nd

lt26

ndnd

NG

40(8)pretermgt

32(5)

nd

Burton

etal1989

8

nd13

LPT

18VD

40nd

nd15

LPT

14Fetald

emise

15weeks

ndnd

LPT

5VD

40nd

ndnd

LPT

5VD

40nd

ndnd

LPT

5VD

40nd

ndnd

LPT

5VD

40nd

ndnd

LPT

5VD

40nd

ndnd

LPT

5nd

ndnd

Rella

etal1980

110

12LP

Tnd

VD

27Neonatald

eath


ble1Con

tinued

Reference

Num

bero

fpatie

nts

Gestatio

nalage

atdiagno

sis(w

eeks)

Gestatio

nalage

atmyomectomy

(weeks)

Type

ofsurgery

Fibroidmaxim

umvolume(cm

)Mod

eofd

elivery

Gestatio

nalage

atdelivery

Neonatal

outcom

e(Apgar

birthw

eightpH

)Pelosietal1995

113

15LP

S6

CS39

ndPelissie

r-Ko

morek

etal2012

110

13LP

T22

VD

352280

g

Mollicae

tal1996

188ndash17

10ndash19

LPT

gt10

CS(17)V

D(1)

ndgt7(18)gt

2500

g(17)lt

2500

g(1)

Febo

etal1997

3nd

12ndash19

LPT

NG

CS(2)abortio

n(1)

37-38

nd

Bonito

etal2007

5nd

9ndash15

LPT

35ndash145

CS(2)VD(3)

382

9+minus083

3200ndash4

072g

Vazqu

ezCa

macho

etal2009

17

16LP

T62

VD

4099

Makar

etal1989

112

17LP

T13500

gCS

38993950

gHorno

Liria

1962

116

16LP

Tnd

VD

403600

gAlanise

tal2008

17

12LP

T30

VD

382330

g

Ardizzone1955

27

88

LPT

ndnd

ndnd

88

LPT

ndnd

ndnd

88

LPT

ndMisc

arria

geat9weeks

2424

LPT

ndFetald

emise

at25

weeks

88

LPT

ndMisc

arria

geat8weeks

1616

LPT

ndnd

ndnd

88

LPT

ndnd

ndnd

88

LPT

ndnd

ndnd

1212

LPT

ndFetald

emise

at14

weeks

2020

LPT

ndnd

ndnd

1616

LPT

ndnd

ndnd

2020

LPT

ndnd

ndnd

2020

LPT

ndnd

ndnd

1212

LPT

ndnd

ndnd

1212

LPT

ndFetald

emise

at13

weeks

88

LPT

ndnd

ndnd

88

LPT

ndnd

ndnd

1212

LPT

ndFetald

emise

at13

weeks

1212

LPT

ndnd

ndnd

1616

LPT

ndFetald

emise

at17

weeks

88

LPT

ndnd

ndnd

1212

LPT

ndnd

ndnd

1212

LPT

ndnd

ndnd

1212

LPT

ndnd

ndnd

88

LPT

ndnd

ndnd

1212

LPT

ndFetald

emise

at12

weeks

1212

LPT

ndnd

ndnd


Table1Con

tinued

Reference

Num

bero

fpatie

nts

Gestatio

nalage

atdiagno

sis(w

eeks)

Gestatio

nalage

atmyomectomy

(weeks)

Type

ofsurgery

Fibroidmaxim

umvolume(cm

)Mod

eofd

elivery

Gestatio

nalage

atdelivery

Neonatal

outcom

e(Apgar

birthw

eightpH

)

Cozzi1967

16

nd12

LPT

ndVD

40nd

nd12

LPT

ndVD

40nd

nd8

LPT

ndVD

40nd

nd8

LPT

ndVD

40nd

nd16

LPT

ndVD

38nd

nd8

LPT

ndVD

40nd

nd12

LPT

ndVD

38nd

nd8

LPT

ndVD

40nd

nd16

LPT

ndVD

40nd

nd20

LPT

ndVD

36nd

nd8

LPT

ndVD

40nd

nd12

LPT

ndVD

40nd

nd12

LPT

ndVD

40nd

nd12

LPT

ndVD

40nd

nd16

LPT

ndVD

40nd

nd8

LPT

ndVD

40nd

Rochetetal1964

14nd

ndLP

T10

ndnd

ndSciann

ameo

etal

1996

120

20LP

T4

ndnd

nd

ndnot

determ

inedC

Scesarean

section

VDvaginaldeliveryLP

TlaparotomyLP

Slap

aroscopyV

AGvaginalsurgery





References












































































of






Disease Markers



OncologyJournal of





PPAR Research



Journal of

ObesityJournal of

















ble1Con

tinued

Reference

Num

bero

fpatie

nts

Gestatio

nalage

atdiagno

sis(w

eeks)

Gestatio

nalage

atmyomectomy

(weeks)

Type

ofsurgery

Fibroidmaxim

umvolume(cm

)Mod

eofd

elivery

Gestatio

nalage

atdelivery

Neonatal

outcom

e(Apgar

birthw

eightpH

)Sentilh

esetal

2003

117

17LP

S5

CS37

3530

g

Lolis

etal2003

13

nd16

LPT

ndCS

373340

gnd

15LP

Tnd

CS39

3600

gnd

19LP

Tnd

CS37

2970

gnd

16LP

Tnd

CS36

3000

gnd

15LP

Tnd

Fetald

emise

at15

weeks

nd15

LPT

ndCS

372740

gnd

16LP

Tnd

CS38

3180

gnd

16LP

Tnd

CS39

3515g

nd16

LPT

ndCS

393190

gnd

19LP

Tnd

CS38

2920

gnd

17LP

Tnd

CS38

3520

gnd

16LP

Tnd

CS38

3000

gnd

15LP

Tnd

CS29

1606

g

Don

neze

tal2002

1Be

fore

pregnancy

25LP

T22

CS35

2280

g

Williamson

1908

122

22LP

T32

VD

23Neonatald

eath

Stew

art1906

120

20LP

T24

VD

40nd

Wittichetal2000

112

15LP

T20

CS37

993275

gMajid

etal1997

117

18LP

T24

Fetald

emise

19weeks

Algarae

tal2015

118

18LP

S7

VD

24nd

Lockyer1914

121

21LP

Tnd

VD

402300

g

vonHoff

mann1911

316

16LP

Tnd

VD

403630

g22

25LP

Tnd

Fetald

emise

at25

weeks

1415

LPT

ndVD

40nd

And

rews1910

1Be

fore

pregnancy

9LP

Tnd

VD

40nd

Swayne1908

220

20LP

Tnd

ndnd

nd16

16LP

Tnd

VD

24nd

Doran1906

120

21LP

T10

VD

40nd

Evans1899

120

20LP

T7

ndnd

ndEx

acou

stosa

ndRo

sati

1993

13nd

lt26

ndnd

NG

40(8)pretermgt

32(5)

nd

Burton

etal1989

8

nd13

LPT

18VD

40nd

nd15

LPT

14Fetald

emise

15weeks

ndnd

LPT

5VD

40nd

ndnd

LPT

5VD

40nd

ndnd

LPT

5VD

40nd

ndnd

LPT

5VD

40nd

ndnd

LPT

5VD

40nd

ndnd

LPT

5nd

ndnd

Rella

etal1980

110

12LP

Tnd

VD

27Neonatald

eath


ble1Con

tinued

Reference

Num

bero

fpatie

nts

Gestatio

nalage

atdiagno

sis(w

eeks)

Gestatio

nalage

atmyomectomy

(weeks)

Type

ofsurgery

Fibroidmaxim

umvolume(cm

)Mod

eofd

elivery

Gestatio

nalage

atdelivery

Neonatal

outcom

e(Apgar

birthw

eightpH

)Pelosietal1995

113

15LP

S6

CS39

ndPelissie

r-Ko

morek

etal2012

110

13LP

T22

VD

352280

g

Mollicae

tal1996

188ndash17

10ndash19

LPT

gt10

CS(17)V

D(1)

ndgt7(18)gt

2500

g(17)lt

2500

g(1)

Febo

etal1997

3nd

12ndash19

LPT

NG

CS(2)abortio

n(1)

37-38

nd

Bonito

etal2007

5nd

9ndash15

LPT

35ndash145

CS(2)VD(3)

382

9+minus083

3200ndash4

072g

Vazqu

ezCa

macho

etal2009

17

16LP

T62

VD

4099

Makar

etal1989

112

17LP

T13500

gCS

38993950

gHorno

Liria

1962

116

16LP

Tnd

VD

403600

gAlanise

tal2008

17

12LP

T30

VD

382330

g

Ardizzone1955

27

88

LPT

ndnd

ndnd

88

LPT

ndnd

ndnd

88

LPT

ndMisc

arria

geat9weeks

2424

LPT

ndFetald

emise

at25

weeks

88

LPT

ndMisc

arria

geat8weeks

1616

LPT

ndnd

ndnd

88

LPT

ndnd

ndnd

88

LPT

ndnd

ndnd

1212

LPT

ndFetald

emise

at14

weeks

2020

LPT

ndnd

ndnd

1616

LPT

ndnd

ndnd

2020

LPT

ndnd

ndnd

2020

LPT

ndnd

ndnd

1212

LPT

ndnd

ndnd

1212

LPT

ndFetald

emise

at13

weeks

88

LPT

ndnd

ndnd

88

LPT

ndnd

ndnd

1212

LPT

ndFetald

emise

at13

weeks

1212

LPT

ndnd

ndnd

1616

LPT

ndFetald

emise

at17

weeks

88

LPT

ndnd

ndnd

1212

LPT

ndnd

ndnd

1212

LPT

ndnd

ndnd

1212

LPT

ndnd

ndnd

88

LPT

ndnd

ndnd

1212

LPT

ndFetald

emise

at12

weeks

1212

LPT

ndnd

ndnd


Table1Con

tinued

Reference

Num

bero

fpatie

nts

Gestatio

nalage

atdiagno

sis(w

eeks)

Gestatio

nalage

atmyomectomy

(weeks)

Type

ofsurgery

Fibroidmaxim

umvolume(cm

)Mod

eofd

elivery

Gestatio

nalage

atdelivery

Neonatal

outcom

e(Apgar

birthw

eightpH

)

Cozzi1967

16

nd12

LPT

ndVD

40nd

nd12

LPT

ndVD

40nd

nd8

LPT

ndVD

40nd

nd8

LPT

ndVD

40nd

nd16

LPT

ndVD

38nd

nd8

LPT

ndVD

40nd

nd12

LPT

ndVD

38nd

nd8

LPT

ndVD

40nd

nd16

LPT

ndVD

40nd

nd20

LPT

ndVD

36nd

nd8

LPT

ndVD

40nd

nd12

LPT

ndVD

40nd

nd12

LPT

ndVD

40nd

nd12

LPT

ndVD

40nd

nd16

LPT

ndVD

40nd

nd8

LPT

ndVD

40nd

Rochetetal1964

14nd

ndLP

T10

ndnd

ndSciann

ameo

etal

1996

120

20LP

T4

ndnd

nd

ndnot

determ

inedC

Scesarean

section

VDvaginaldeliveryLP

TlaparotomyLP

Slap

aroscopyV

AGvaginalsurgery





References












































































of






Disease Markers



OncologyJournal of





PPAR Research



Journal of

ObesityJournal of

















ble1Con

tinued

Reference

Num

bero

fpatie

nts

Gestatio

nalage

atdiagno

sis(w

eeks)

Gestatio

nalage

atmyomectomy

(weeks)

Type

ofsurgery

Fibroidmaxim

umvolume(cm

)Mod

eofd

elivery

Gestatio

nalage

atdelivery

Neonatal

outcom

e(Apgar

birthw

eightpH

)Pelosietal1995

113

15LP

S6

CS39

ndPelissie

r-Ko

morek

etal2012

110

13LP

T22

VD

352280

g

Mollicae

tal1996

188ndash17

10ndash19

LPT

gt10

CS(17)V

D(1)

ndgt7(18)gt

2500

g(17)lt

2500

g(1)

Febo

etal1997

3nd

12ndash19

LPT

NG

CS(2)abortio

n(1)

37-38

nd

Bonito

etal2007

5nd

9ndash15

LPT

35ndash145

CS(2)VD(3)

382

9+minus083

3200ndash4

072g

Vazqu

ezCa

macho

etal2009

17

16LP

T62

VD

4099

Makar

etal1989

112

17LP

T13500

gCS

38993950

gHorno

Liria

1962

116

16LP

Tnd

VD

403600

gAlanise

tal2008

17

12LP

T30

VD

382330

g

Ardizzone1955

27

88

LPT

ndnd

ndnd

88

LPT

ndnd

ndnd

88

LPT

ndMisc

arria

geat9weeks

2424

LPT

ndFetald

emise

at25

weeks

88

LPT

ndMisc

arria

geat8weeks

1616

LPT

ndnd

ndnd

88

LPT

ndnd

ndnd

88

LPT

ndnd

ndnd

1212

LPT

ndFetald

emise

at14

weeks

2020

LPT

ndnd

ndnd

1616

LPT

ndnd

ndnd

2020

LPT

ndnd

ndnd

2020

LPT

ndnd

ndnd

1212

LPT

ndnd

ndnd

1212

LPT

ndFetald

emise

at13

weeks

88

LPT

ndnd

ndnd

88

LPT

ndnd

ndnd

1212

LPT

ndFetald

emise

at13

weeks

1212

LPT

ndnd

ndnd

1616

LPT

ndFetald

emise

at17

weeks

88

LPT

ndnd

ndnd

1212

LPT

ndnd

ndnd

1212

LPT

ndnd

ndnd

1212

LPT

ndnd

ndnd

88

LPT

ndnd

ndnd

1212

LPT

ndFetald

emise

at12

weeks

1212

LPT

ndnd

ndnd


Table1Con

tinued

Reference

Num

bero

fpatie

nts

Gestatio

nalage

atdiagno

sis(w

eeks)

Gestatio

nalage

atmyomectomy

(weeks)

Type

ofsurgery

Fibroidmaxim

umvolume(cm

)Mod

eofd

elivery

Gestatio

nalage

atdelivery

Neonatal

outcom

e(Apgar

birthw

eightpH

)

Cozzi1967

16

nd12

LPT

ndVD

40nd

nd12

LPT

ndVD

40nd

nd8

LPT

ndVD

40nd

nd8

LPT

ndVD

40nd

nd16

LPT

ndVD

38nd

nd8

LPT

ndVD

40nd

nd12

LPT

ndVD

38nd

nd8

LPT

ndVD

40nd

nd16

LPT

ndVD

40nd

nd20

LPT

ndVD

36nd

nd8

LPT

ndVD

40nd

nd12

LPT

ndVD

40nd

nd12

LPT

ndVD

40nd

nd12

LPT

ndVD

40nd

nd16

LPT

ndVD

40nd

nd8

LPT

ndVD

40nd

Rochetetal1964

14nd

ndLP

T10

ndnd

ndSciann

ameo

etal

1996

120

20LP

T4

ndnd

nd

ndnot

determ

inedC

Scesarean

section

VDvaginaldeliveryLP

TlaparotomyLP

Slap

aroscopyV

AGvaginalsurgery





References












































































of






Disease Markers



OncologyJournal of





PPAR Research



Journal of

ObesityJournal of

















Table1Con

tinued

Reference

Num

bero

fpatie

nts

Gestatio

nalage

atdiagno

sis(w

eeks)

Gestatio

nalage

atmyomectomy

(weeks)

Type

ofsurgery

Fibroidmaxim

umvolume(cm

)Mod

eofd

elivery

Gestatio

nalage

atdelivery

Neonatal

outcom

e(Apgar

birthw

eightpH

)

Cozzi1967

16

nd12

LPT

ndVD

40nd

nd12

LPT

ndVD

40nd

nd8

LPT

ndVD

40nd

nd8

LPT

ndVD

40nd

nd16

LPT

ndVD

38nd

nd8

LPT

ndVD

40nd

nd12

LPT

ndVD

38nd

nd8

LPT

ndVD

40nd

nd16

LPT

ndVD

40nd

nd20

LPT

ndVD

36nd

nd8

LPT

ndVD

40nd

nd12

LPT

ndVD

40nd

nd12

LPT

ndVD

40nd

nd12

LPT

ndVD

40nd

nd16

LPT

ndVD

40nd

nd8

LPT

ndVD

40nd

Rochetetal1964

14nd

ndLP

T10

ndnd

ndSciann

ameo

etal

1996

120

20LP

T4

ndnd

nd

ndnot

determ

inedC

Scesarean

section

VDvaginaldeliveryLP

TlaparotomyLP

Slap

aroscopyV

AGvaginalsurgery





References












































































of






Disease Markers



OncologyJournal of





PPAR Research



Journal of

ObesityJournal of




















References












































































of






Disease Markers



OncologyJournal of





PPAR Research



Journal of

ObesityJournal of































































of






Disease Markers



OncologyJournal of





PPAR Research



Journal of

ObesityJournal of


























of






Disease Markers



OncologyJournal of





PPAR Research



Journal of

ObesityJournal of





















of






Disease Markers



OncologyJournal of





PPAR Research



Journal of

ObesityJournal of
















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