O-094 Pregnancy complications in women with in-situ uterine fibroids compared to women without fibroids. From an American population database with almost 90,000 women with fibroids
Notice bibliographique
Résumé
Abstract Study question Data on pregnancy complications in women with intramural fibroids remain limited and controversial. Do intramural fibroids increase obstetric complications, compared to those without fibroids? Summary answer In-situ fibroids pregnancies experienced more complications including hypertensive disorders, premature rupture of membranes, preterm-delivery, placenta-previa, cesareans, uterine rupture, wound complications, transfusions, and small birthweight. What is known already Patients with uterine fibroids experience reduced fertility rates and increased obstetrical complications compared to patients without fibroids. If these data are well documented for submucosal fibroids, it is still controversial for intramural fibroids. These discrepancies may be attributed to small sample sizes and limited statistical power in many studies, as well as a lack of comprehensive reporting on a wide range of outcomes, with meta-analysis focusing solely on one specific outcome. However, no nationwide database has attempted a detailed analysis of the demographic, maternal, pregnancy, delivery, and neonatal outcomes in women with uterine fibroids compared to those without fibroids. Study design, size, duration Retrospective cohort study, using the Healthcare Cost and Utilization Project Nationwide Inpatient Sample between 2004 and 2014, inclusively, based on International Classification of Diseases, 9th edition, diagnoses (ICD-9). Data was collected from 48 states and the District of Columbia, representing 20% of annual hospital admissions in the United States. Population-based study, including 89,317 patients with intramural in-situ fibroids uteri and 9,071,744 controls without uterine fibroids (UF). Participants/materials, setting, methods We included patients with delivery discharge diagnoses or maternal deaths, and intramural in-situ uterine fibroids (ICD-9 codes 218.0, 218.1, 218.2), excluding those of submucosal type (218.9), and no previous myomectomy, and a control group without UF. Multivariate logistic regression was used and adjusted for age, race, income quartiles, smoking, previous cesarean section, chronic and pregnancy-induced hypertension, obesity, multiple gestations, pre-gestational and gestational diabetes mellitus, thyroid disease, IVF use. Main results and the role of chance UF group included older patients with higher BMIs, greater use of IVF, and higher rates of Black and Asian ethnicity, chronic hypertension, pregestational diabetes, and multiple gestations, compared to the no-fibroid group. UF patients demonstrated increased risks of gestational hypertension [adjusted odd ratios (aOR 1.40, 95% confidence intervals (CI) 1.36-1.45)], pregnancy induced hypertension (aOR 1.68, 95%CI 1.65-1.72), preeclampsia (aOR 1.85, 95%CI 1.80-1.90) eclampsia (aOR 1.52, 95%CI 1.22-1.89), gestational diabetes mellitus (aOR 1.27, 95%CI 1.24-1.30), preterm delivery (aOR 1.45, 95%CI 1.42-1.49), preterm premature rupture of membranes (aOR 1.58, 95%CI 1.51-1.66), placenta previa (aOR 2.40 95%CI 2.28-2.52), placenta abruption (aOR 1.69, 95%CI 1.61-1.77), chorioamnionitis (aOR 1.83, 95%CI 1.75-1.90), cesarean delivery (aOR 7.26, 95%CI 7.14-7.38), uterine rupture (aOR 1.26, 95%CI 1.03-1.53), hysterectomy peri-delivery (aOR 3.15, 95%CI 2.85- 3.74), wound complications (aOR 1.77, 95%CI 1.65-1.90), postpartum hemorrhage (aOR 1.28, 95%CI 1.24-1.33), transfusion (aOR 2.02, 95%CI 1.93-2.11), deep venous thrombosis (aOR 1.62 95%CI 1.30-2.03), pulmonary embolism (aOR 1.96, 95%CI 1.47-2.63), and disseminated intravascular coagulation (aOR 1.52, 95% CI 1.37-1.68), and small for gestational age infants (aOR 1.90, 95%CI 1.83-1.96) compared to the no-fibroid group. No difference in intra-uterine fetal death rate (aOR 0.95, 95%CI 0.86-1.05), and in maternal death, (aOR 0.56, 95%CI 0.26-1.18) was highlighted. Limitations, reasons for caution The retrospective basis of the study may mask bias. Moreover, the risks associated with uterine rupture, maternal mortality, and thromboembolic events were based on limited cases and require further investigation. Further prospective and large retrospective studies are needed to improve counseling and outcomes in infertile patients with uterine fibroids. Wider implications of the findings In theory, chronic inflammation or cytokine imbalances associated with intramural UFs may impair trophoblast invasion, leading to hypertensive disorders, abnormal placentation, and compromised fetal growth. Comprehensive counselling on these risks, and the one associated with pregnancy post-myomectomy, are essential before conception, given the significant obstetric challenges with both scenarios present. Trial registration number No
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,001 | 0,005 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,001 | 0,002 |
| Bibliométrie | 0,002 | 0,003 |
| Études des sciences et des technologies | 0,000 | 0,000 |
| Communication savante | 0,001 | 0,000 |
| Science ouverte | 0,000 | 0,001 |
| Intégrité de la recherche | 0,000 | 0,001 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,002 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».