子宫肌瘤体积妊娠期变化及其与妊娠结局的相关性分析

Analysis of the change of uterine fibroids volume during pregnancy and its correlation with pregnancy outcome

目的观察子宫肌瘤体积妊娠期变化,并分析其影响因素及对妊娠结局的影响。方法回顾性分析2018年1月1日至2019年1月1日在首都医科大学附属北京友谊医院建档、规律产检至妊娠结局的456例单发子宫肌瘤孕妇的临床资料,根据超声检查时间将孕前至妊娠结束分为5个阶段:孕前至孕6~8周为I阶段;孕6~8周至孕12~14周为II阶段;孕12~14周至孕22~24周为III阶段;孕22~24周至孕30~32周为IV阶段;孕30~32周至孕36~38周为V阶段。收集子宫肌瘤直径及体积以及患者相关临床资料,计算肌瘤直径与体积在各阶段阶段的增长情况;分析其影响因素及与妊娠结局的相关性。结果5个阶段子宫肌瘤体积增长率分别92.9%、72.8%、65.3%、34.2%、31.2%,全孕期增长率为62.5%。孕妇年龄、产次、孕前肌瘤大小、早孕期应用孕激素均与肌瘤变化无关。孕前及分娩前体重指数、妊娠期糖尿病与V阶段肌瘤体积增大呈正相关(OR=1.21、1.17、4.94,P=0.005,、0.016/0.001)。肌壁间肌瘤相较于浆膜下肌瘤在早孕期更容易增大(OR=14.00,P=0.008)。IV阶段肌瘤体积增长显著者及浆膜下肌瘤孕期易出现红色变性(OR=1.34、1893.50,P=0.005)。肌瘤与胎盘关系与肌瘤体积变化无关。妊娠期间子宫肌瘤直径<5 cm与胎膜早破及早产、胎盘早剥无关。结论子宫肌瘤体积在妊娠期呈抛物线式变化,全孕期为增长趋势。I^III阶段或III阶段肌瘤增长缓慢或缩小,而IV阶段肌瘤生长迅速者及浆膜下肌瘤者应警惕肌瘤变性。体重指数异常及妊娠期糖尿病患者应注意孕晚期肌瘤变化。妊娠期直径<5 cm的肌瘤与胎膜早破及早产、胎盘早剥无关。子宫肌瘤患者孕前需充分告知风险,根据肌瘤大小、位置及患者状况进行个体化治疗。

Objective To observe the growth trend of uterine fibroids volume during the pregnancy,analyze the influencing factors and the associations between fibroids and pregnancy outcomes.Methods A retrospective study was conducted on 456 patients with single fibroids from pre-pregnancy to delivery.According to the ultrasound time,the observed period from pre-pregnancy to delivery was divided into 5 stages:at pre-pregnancy to 6-8 gestation weeks as stage I,6~8 to 12~14 gestation weeks as stage II,12~14 to 22~24 gestation weeks as stage III,22~24 to 30~32 gestation weeks as stage IV,30~32 to 36~38 gestation weeks as stage V.The diameter and volume of fibroids and other clinical data were recorded,the growth rate of diameter and volume of fibroids in each stage were calculated,and risk factors and its association with pregnancy outcome were analyzed.Results Growth rates of fibroids volume in five stages and during the whole pregnancy were 92.9%,72.8%,65.3%,34.2%,31.2%and 62.5%,respectively.The maternal,parity,the size of the fibroids before pregnancy,and the use of progestin in early pregnancy were not related to the changes of the fibroids.There was a positive correlation between body mass index pre-pregnancy and before delivery,gestational diabetes mellitus(GDM)with increased fibroid volume in stage V(OR=1.21,1.17,4.94,P=0.005,0.016,0.001).Compared with subserosal fibroids,intramuscular fibroids are more likely to increase in early pregnancy(OR=14.00,P=0.008).The fibroids with significant increase in stage IV and subserosal fibroids were more likely to prone to red degeneration(OR=1.34、1893.50,P=0.005)The relationship between fibroids and placenta was not related to changes of fibroid volume.Uterine fibroids<5 cm in diameter were not associated with premature rupture of membrane(PROM),placental abruption or premature labor.Conclusion The volume of uterine fibroids shows a parabolic change during gestation and increases during the whole pregnancy.Those fibroids growing slowly or shrink in stage I to III or III,and growing rapidly in stage IV and the subserosal fibroids should be wary of fibroid red degeneration.Patients with high BMI and diabetes should pay attention to the change of fibroids in late pregnancy.Fibroids<5 cm in diameter during gestation are not associated with premature rupture of membranes,preterm delivery or placental abruption.Patients with uterine fibroids should be fully informed of the risks before pregnancy,and be treated individually according to the size and location of the fibroids and the patients'condition.