Abstract
Background: Some studies have shown a relationship between uterine fibroids and PPH, while other studies have not shown a risk increase for PPH with uterine fibroids.
Objective: The aim of performing the present study was in order to assess the association between uterine leiomyoma and postpartum hemorrhage (PPH) based on epidemiology studies.
Methods: We searched for several major international databases (PubMed, Scopus, EBSCO and Web of Science) till Oct 2019. OR was used to measure the association between uterine leiomyoma and postpartum hemorrhage. The combined OR and the corresponding 95 % CI were calculated using random-effects models. In order to control potential confounders, a meta-analysis was carried out based on crude and adjusted form. Homogeneity of effect size was tested by using the Q statistic and to measure the inconsistency across studies and the I2 statistic was used. Funnel plot and the Begg's test was employed to assess possible publication bias. Data were analyzed by the Stata software, version 14, with significance level 0.05.
Results: Based on OR estimates obtained from adjusted studies, there was a significant relationship between the uterine leiomyoma and PPH (OR=1.44; 95% CI: 1.14, 1.73). We assessed the association according to statistical adjustment for confounding factors (crude/adjusted) and the association between uterine leiomyoma and PPH in both crude (OR=1.96; 95% CI: 1.03, 2.88) and adjusted (OR=1.23; 95% CI: 1.02, 1.44) report was statistically significant.
Conclusion: In this study, uterine leiomyoma was a risk factor for PPH. Therefore, based on our findings in pregnant women with uterine leiomyoma, clinicians should be prepared to manage postpartum hemorrhage after vaginal births and cesarean deliveries.
Keywords: Uterine leiomyoma, postpartum hemorrhage, meta-analysis, epidemiology studies, risk factor, pregnancy.
Graphical Abstract
[1]
Zhao R, Wang X, Zou L, et al. Adverse obstetric outcomes in pregnant women with uterine fibroids in China: A multicenter survey involving 112,403 deliveries. PLoS One 2017; 12(11)e0187821
[http://dx.doi.org/10.1371/journal.pone.0187821 ] [PMID: 29136018]
[http://dx.doi.org/10.1371/journal.pone.0187821 ] [PMID: 29136018]
[2]
Drayer SM, Catherino WH. Prevalence, morbidity, and current medical management of uterine leiomyomas. Int J Gynaecol Obstet 2015; 131(2): 117-22.
[http://dx.doi.org/10.1016/j.ijgo.2015.04.051 ] [PMID: 26275638]
[http://dx.doi.org/10.1016/j.ijgo.2015.04.051 ] [PMID: 26275638]
[3]
Chill HH, Karavani G, Rachmani T, Dior U, Tadmor O, Shushan A. Growth pattern of uterine leiomyoma along pregnancy. BMC Womens Health 2019; 19(1): 100.
[http://dx.doi.org/10.1186/s12905-019-0803-5 ] [PMID: 31331317]
[http://dx.doi.org/10.1186/s12905-019-0803-5 ] [PMID: 31331317]
[4]
Egbe TO, Badjang TG, Tchounzou R, Egbe E-N, Ngowe MN. Uterine fibroids in pregnancy: prevalence, clinical presentation, associated factors and outcomes at the Limbe and Buea Regional Hospitals, Cameroon: a cross-sectional study. BMC Res Notes 2018; 11(1): 889.
[http://dx.doi.org/10.1186/s13104-018-4007-0 ] [PMID: 30545402]
[http://dx.doi.org/10.1186/s13104-018-4007-0 ] [PMID: 30545402]
[5]
Donnez J, Hudecek R, Donnez O, et al. Efficacy and safety of repeated use of ulipristal acetate in uterine fibroids. Fertil Steril 2015; 103(2): 519-27.e3.
[http://dx.doi.org/10.1016/j.fertnstert.2014.10.038]
[http://dx.doi.org/10.1016/j.fertnstert.2014.10.038]
[6]
Islam MS, Greco S, Janjusevic M, et al. Growth factors and pathogenesis. Best Pract Res Clin Obstet Gynaecol 2016; 34: 25-36.
[http://dx.doi.org/10.1016/j.bpobgyn.2015.08.018 ] [PMID: 26527305]
[http://dx.doi.org/10.1016/j.bpobgyn.2015.08.018 ] [PMID: 26527305]
[7]
Jamshaid A, Arshad Z, Zaidi SZ. Leiomyoma of the urinary bladder. J Pak Med Assoc 2017; 67(9): 1447-9.
[PMID: 28924293]
[PMID: 28924293]
[8]
Arisoy R, Erdogdu E, Bostancι E, et al. Obstetric outcomes of intramural leiomyomas in pregnancy. Clin Exp Obstet Gynecol 2016; 43(6): 844-8.
[PMID: 29944235]
[PMID: 29944235]
[9]
Ezzedine D, Norwitz ER. Are women with uterine fibroids at increased risk for adverse Pregnancy outcome? Clin Obstet Gynecol 2016; 59(1): 119-27.
[http://dx.doi.org/10.1097/GRF.0000000000000169 ] [PMID: 26670833]
[http://dx.doi.org/10.1097/GRF.0000000000000169 ] [PMID: 26670833]
[10]
Harlev A, Wainstock T, Walfisch A, Landau D, Sheiner E. Perinatal outcome and long-term pediatric morbidity of pregnancies with a fibroid uterus. Early Hum Dev 2019; 129: 33-7.
[http://dx.doi.org/10.1016/j.earlhumdev.2019.01.004 ] [PMID: 30639463]
[http://dx.doi.org/10.1016/j.earlhumdev.2019.01.004 ] [PMID: 30639463]
[11]
Martin J, Ulrich ND, Duplantis S, Williams FB, Luo Q, Moore RC. Obstetrical outcomes of ultrasound identified uterine fibroids in pregnancy. Am J Perinatol 2016; 33(12): 1218-22.
[http://dx.doi.org/10.1055/s-0036-1593389 ] [PMID: 27631601]
[http://dx.doi.org/10.1055/s-0036-1593389 ] [PMID: 27631601]
[12]
Ouyang DW, Norwitz ER. Pregnancy in women with uterine leiomyomas
(fibroids). Literature review current through. 2017. Available
from: http://enjoypregnancyclub.com/wp-content/uploads/2017/06/Pregnancy%20in%20women%20with%20uterine%20leiomyomas %20(fibroids).pdf [Accessed on: Feb 2, 2020].
[13]
WHO. WHO recommendations for the prevention and treatment of
postpartum haemorrhage: World Health Organization 2012. Available
from: https://www.who.int/reproductivehealth/publications/maternal_perinatal_health/9789241548502/en/ [Accessed on: Feb
2, 2020].
[14]
Ford JB, Patterson JA, Seeho SK, Roberts CL. Trends and outcomes of postpartum haemorrhage, 2003-2011. BMC Pregnancy Childbirth 2015; 15(1): 334.
[http://dx.doi.org/10.1186/s12884-015-0788-5 ] [PMID: 26670767]
[http://dx.doi.org/10.1186/s12884-015-0788-5 ] [PMID: 26670767]
[15]
Yi SW. Extravasating uterine pseudoaneurysm: A rare cause of postpartum haemorrhage. J Obstet Gynaecol 2017; 37(4): 416-20.
[http://dx.doi.org/10.1080/01443615.2016.1274292 ] [PMID: 28421908]
[http://dx.doi.org/10.1080/01443615.2016.1274292 ] [PMID: 28421908]
[16]
Habitamu D, Goshu YA, Zeleke LB. The magnitude and associated factors of postpartum hemorrhage among mothers who delivered at Debre Tabor general hospital 2018. BMC Res Notes 2019; 12(1): 618.
[http://dx.doi.org/10.1186/s13104-019-4646-9 ] [PMID: 31547856]
[http://dx.doi.org/10.1186/s13104-019-4646-9 ] [PMID: 31547856]
[17]
Marshall AL, Durani U, Bartley A, et al. The impact of postpartum hemorrhage on hospital length of stay and inpatient mortality: a National Inpatient Sample-based analysis. Am J Obstet Gynecol 2017; 217(3): 344.e1-6.
[http://dx.doi.org/10.1016/j.ajog.2017.05.004 ] [PMID: 28502758]
[http://dx.doi.org/10.1016/j.ajog.2017.05.004 ] [PMID: 28502758]
[18]
Saha MM, Mondal D, Biswas SC. Pregnancy with leiomyoma uteri and feto-maternal outcomes. Al Ameen J Med Sci 2016; 9: 96-100.
[19]
Qidwai GI, Caughey AB, Jacoby AF. Obstetric outcomes in women with sonographically identified uterine leiomyomata. Obstet Gynecol 2006; 107(2 Pt 1): 376-82.
[http://dx.doi.org/10.1097/01.AOG.0000196806.25897.7c ] [PMID: 16449127]
[http://dx.doi.org/10.1097/01.AOG.0000196806.25897.7c ] [PMID: 16449127]
[20]
Wang HM, Tian YC, Xue ZF, Zhang Y, Dai YM. Associations between uterine fibroids and obstetric outcomes in twin pregnancies. Int J Gynaecol Obstet 2016; 135(1): 22-7.
[http://dx.doi.org/10.1016/j.ijgo.2016.04.013 ] [PMID: 27522320]
[http://dx.doi.org/10.1016/j.ijgo.2016.04.013 ] [PMID: 27522320]
[21]
Vergani P, Ghidini A, Strobelt N, et al. Do uterine leiomyomas influence pregnancy outcome? Am J Perinatol 1994; 11(5): 356-8.
[http://dx.doi.org/10.1055/s-2007-994554 ] [PMID: 7993518]
[http://dx.doi.org/10.1055/s-2007-994554 ] [PMID: 7993518]
[22]
Klatsky PC, Tran ND, Caughey AB, Fujimoto VY. Fibroids and reproductive outcomes: a systematic literature review from conception to delivery. Am J Obstet Gynecol 2008; 198(4): 357-66.
[http://dx.doi.org/10.1016/j.ajog.2007.12.039 ] [PMID: 18395031]
[http://dx.doi.org/10.1016/j.ajog.2007.12.039 ] [PMID: 18395031]
[23]
Arya S, Schwartz TA, Ghaferi AA. Practical Guide to Meta-analysis. JAMA Surg 2020.
[http://dx.doi.org/10.1001/jamasurg.2019.4523 ] [PMID: 31995161]
[http://dx.doi.org/10.1001/jamasurg.2019.4523 ] [PMID: 31995161]
[24]
Wells GA, Shea B, O’Connell D, et al. The Newcastle-Ottawa Scale (NOS) for assessing the quality of nonrandomised studies in meta-analyses. Ontario: Ottawa Hospital Research Institute 2009. Available from:
http://www.ohri.ca/programs/clinical_epidemiology/oxford.asp [Accessed on: March 25, 2014].
[25]
Higgins JP, Green S. Cochrane handbook for systematic reviews of interventions. John Wiley & Sons 2011.
[26]
Begg CB, Mazumdar M. Operating characteristics of a rank correlation test for publication bias. Biometrics 1994; 50(4): 1088-101.
[http://dx.doi.org/10.2307/2533446 ] [PMID: 7786990]
[http://dx.doi.org/10.2307/2533446 ] [PMID: 7786990]
[27]
Conti N, Tosti C, Pinzauti S, et al. Uterine fibroids affect pregnancy outcome in women over 30 years old: role of other risk factors. J Matern Fetal Neonatal Med 2013; 26(6): 584-7.
[http://dx.doi.org/10.3109/14767058.2012.745504 ] [PMID: 23126572]
[http://dx.doi.org/10.3109/14767058.2012.745504 ] [PMID: 23126572]
[28]
Ortiz FM, Romero BP, Romero EP, et al. Uterine fibroids during pregnancy and their impact on the obstetric outcome. Ginecol Obstet Mex 2011; 79(8): 467-73.
[PMID: 21966843]
[PMID: 21966843]
[29]
Iqbal M, Akhtar Z, Jamal T. Outcome of pregnancies associated with fibroids. J Med Sci 2014; 22(1): 3-5.
[30]
Nyfløt LT, Sandven I, Stray-Pedersen B, et al. Risk factors for severe postpartum hemorrhage: a case-control study. BMC Pregnancy Childbirth 2017; 17(1): 17.
[http://dx.doi.org/10.1186/s12884-016-1217-0 ] [PMID: 28068990]
[http://dx.doi.org/10.1186/s12884-016-1217-0 ] [PMID: 28068990]
[31]
Coronado GD, Marshall LM, Schwartz SM. Complications in pregnancy, labor, and delivery with uterine leiomyomas: a population-based study. Obstet Gynecol 2000; 95(5): 764-9.
[http://dx.doi.org/10.1097/00006250-200005000-00025 ] [PMID: 10775744]
[http://dx.doi.org/10.1097/00006250-200005000-00025 ] [PMID: 10775744]
[32]
Ekin A, Gezer C, Solmaz U, Taner CE, Dogan A, Ozeren M. Predictors of severity in primary postpartum hemorrhage. Arch Gynecol Obstet 2015; 292(6): 1247-54.
[http://dx.doi.org/10.1007/s00404-015-3771-5 ] [PMID: 26041324]
[http://dx.doi.org/10.1007/s00404-015-3771-5 ] [PMID: 26041324]
[33]
Kramer MS, Berg C, Abenhaim H, et al. Incidence, risk factors, and temporal trends in severe postpartum hemorrhage. Am J Obstet Gynecol 2013; 209(5): 449.e1-7.
[http://dx.doi.org/10.1016/j.ajog.2013.07.007 ] [PMID: 23871950]
[http://dx.doi.org/10.1016/j.ajog.2013.07.007 ] [PMID: 23871950]
[34]
Oberg AS, Hernandez-Diaz S, Palmsten K, Almqvist C, Bateman BT. Patterns of recurrence of postpartum hemorrhage in a large population-based cohort. Am J Obstet Gynecol 2014; 210(3): 229.e1-8.
[http://dx.doi.org/10.1016/j.ajog.2013.10.872 ] [PMID: 24351791]
[http://dx.doi.org/10.1016/j.ajog.2013.10.872 ] [PMID: 24351791]
[35]
Vergani P, Locatelli A, Ghidini A, Andreani M, Sala F, Pezzullo JC. Large uterine leiomyomata and risk of cesarean delivery. Obstet Gynecol 2007; 109(2 Pt 1): 410-4.
[http://dx.doi.org/10.1097/01.AOG.0000250470.78700.f0 ] [PMID: 17267843]
[http://dx.doi.org/10.1097/01.AOG.0000250470.78700.f0 ] [PMID: 17267843]
[36]
Palmsten K, Hernández-Díaz S, Huybrechts KF, et al. Use of antidepressants near delivery and risk of postpartum hemorrhage: cohort study of low income women in the United States. BMJ 2013; 347: f4877.
[http://dx.doi.org/10.1136/bmj.f4877 ] [PMID: 23965506]
[http://dx.doi.org/10.1136/bmj.f4877 ] [PMID: 23965506]
[37]
Lam SJ, Best S, Kumar S. The impact of fibroid characteristics on pregnancy outcome. Am J Obstet Gynecol 2014; 211(4): 395.e1-5.
[http://dx.doi.org/10.1016/j.ajog.2014.03.066 ] [PMID: 24705132]
[http://dx.doi.org/10.1016/j.ajog.2014.03.066 ] [PMID: 24705132]
[38]
Navid S, Arshad S. Qurat-ul-Ain, Meo RA. Impact of leiomyoma in pregnancy. J Ayub Med Coll Abbottabad 2012; 24(1): 90-2.
[PMID: 23855105]
[PMID: 23855105]
[39]
Surrey ES, Minjarez DA, Stevens JM, Schoolcraft WB. Effect of myomectomy on the outcome of assisted reproductive technologies. Fertil Steril 2005; 83(5): 1473-9.
[http://dx.doi.org/10.1016/j.fertnstert.2004.11.045 ] [PMID: 15866587]
[http://dx.doi.org/10.1016/j.fertnstert.2004.11.045 ] [PMID: 15866587]
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