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
Bibliographic record
Abstract
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
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.005 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.002 |
| Bibliometrics | 0.002 | 0.003 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.001 | 0.000 |
| Open science | 0.000 | 0.001 |
| Research integrity | 0.000 | 0.001 |
| Insufficient payload (model declined to judge) | 0.002 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".