Специфика ведения беременности у пациенток с миомой матки. Клинический случай

Доброхотова Ю.Э., Данелян С.Ж., Боровкова Е.И., Нагайцева Е.А., Сарахова Д.Х., Селимшаева Д.С., Боровская К.А. Специфика ведения беременности у пациенток с миомой матки. Клинический случай. Гинекология. 2021; 23 (5): 448–453.
DOI: 10.26442/20795696.2021.5.200777

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Dobrokhotova IuE, Danelian SZh, Borovkova EI, Nagaitseva EA, Sarakhova DKh, Selimshaeva DS, Borovskaia KA. Pregnancy management in patients with uterine fibroids. Case report. Gynecology. 2021; 23 (5): 448–453.
DOI: 10.26442/20795696.2021.5.200777

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Аннотация

Миома матки (ММ) является самой распространенной опухолью у женщин репродуктивного возраста. Рост миоматозных узлов во время беременности носит нелинейный характер и преимущественно происходит в I триместре. В большинстве случаев ММ не отягощает течение беременности. Большой размер (>5 см), ретроплацентарное расположение и/или деформация полости матки миоматозным узлом связаны с повышенными рисками самопроизвольного выкидыша, отслойки плаценты, кровотечения, преждевременных родов и кесарева сечения. Миомэктомия во время беременности нежелательна, при развитии болевого синдрома безопасным является применение ацетаминофена. Показаниями к кесареву сечению при ММ являются миома большого размера, препятствующая родам через естественные родовые пути, «красная дегенерация» миоматозных узлов, перекрут субсерозного миоматозного узла (степень 2С).

Ключевые слова: миома матки, беременность, ультразвуковое исследование, миомэктомия

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Uterine fibroids (UF) are the most common tumor in women of reproductive age. The growth of myomatous nodes during pregnancy is non-linear and mainly occurs in the first trimester. In most cases, UF do not burden the course of pregnancy. Large size (>5 cm), retroplacental location, and/or deformity of the uterine cavity by the myomatous node are associated with increased risks of spontaneous miscarriage, placental abruption, bleeding, preterm birth, and cesarean section. Myomectomy during pregnancy is undesirable, with the development of pain syndrome, the use of acetaminophen is safe. Indications for cesarean section in UF are the presence of a large size of fibroids that prevent delivery through the natural birth canal, “red degeneration” of myomatous nodes, torsion of the subserous myomatous node (degree 2C).

Keywords: uterine fibroids, pregnancy, ultrasound, myomectomy

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Список литературы

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31. Kwon SY, Lee G, Kim YS. Management of severely painful uterine leiomyoma in a pregnant woman with epidural block using a subcutaneous injection port. Acta Obstet Gynecol Scand. 2014;93:839.
32. Moridaira T, Yamamoto G, Hiraishi M, et al. A case of continuous epidural anesthesia for pain relief in a pregnant woman with uterine myoma in the second trimester of pregnancy. Masui. 2013;62:1253 (in Japanes).
33. Ehigiegba AE, Ande AB, Ojobo SI. Myomectomy during cesarean section. Int J Gynaecol Obstet. 2001;75:21.
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35. ACOG Committee Opinion No. 764: Medically Indicated Late-Preterm and Early-Term Deliveries. Obstet Gynecol. 2019;133:e151.

________________________________________________

1. Qidwai GI, Caughey AB, Jacoby AF. Obstetric outcomes in women with sonographically identified uterine leiomyomata. Obstet Gynecol. 2006; 107:376.
2. Dobrokhotova IuE, Il’ina IIu, Goncharov IIu. Mioma matki. Bezoperatsionnoe lechenie. RMZh. Mat’ i ditia. 2018;2(1):3–6 (in Russian).
3. Terry KL, De Vivo I, Hankinson SE, Missmer SA. Reproductive characteristics and risk of uterine leiomyomata. Fertil Steril. 2010;94:2703.
4. Ciavattini A, Delli Carpini G, Clemente N, et al. Growth trend of small uterine fibroids and human chorionic gonadotropin serum levels in early pregnancy: an observational study. Fertil Steril. 2016;05:1255.
5. Laughlin SK, Hartmann KE, Baird DD. Postpartum factors and natural fibroid regression. Am J Obstet Gynecol. 2011;204:496.e1.
6. Lam SJ, Best S, Kumar S. The impact of fibroid characteristics on pregnancy outcome. Am J Obstet Gynecol. 2014;211:395.e1.
7. Parker WH. Etiology, symptomatology, and diagnosis of uterine myomas. Fertil Steril. 2007;87:725.
8. De Carolis S, Fatigante G, Ferrazzani S, et al. Uterine myomectomy in pregnant women. Fetal Diagn Ther. 2001;16:116.
9. Benson CB, Chow JS, Chang-Lee W, et al. Outcome of pregnancies in women with uterine leiomyomas identified by sonography in the first trimester. J Clin Ultrasound. 2001;29:261.
10. Dobrokhotova IuE, Ibragimova DM, Saprykina LV. Uterine fibroids. Moscow: GEOTAR-Media, 2018 (in Russian).
11. Sundermann AC, Velez Edwards DR, Bray MJ, et al. Leiomyomas in Pregnancy and Spontaneous Abortion: A Systematic Review and Meta-analysis. Obstet Gynecol. 2017;130:1065.
12. 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;198:357.
13. Girault A, Le Ray C, Chapron C, et al. Leiomyomatous uterus and preterm birth: an exposed/unexposed monocentric cohort study. Am J Obstet Gynecol. 2018;219:410.e1.
14. Coronado GD, Marshall LM, Schwartz SM. Complications in pregnancy, labor, and delivery with uterine leiomyomas: a population-based study. Obstet Gynecol. 2000;95:764.
15. Forssman L. Distribution of blood flow in myomatous uteri as measured by locally injected 133Xenon. Acta Obstet Gynecol Scand. 1976;55:101.
16. Romero R, Chervenak FA, DeVore G, et al. Fetal head deformation and congenital torticollis associated with a uterine tumor. Am J Obstet Gynecol. 1981;141:839.
17. Koike T, Minakami H, Kosuge S, et al. Uterine leiomyoma in pregnancy: its influence on obstetric performance. J Obstet Gynaecol Res. 1999;25:309.
18. Sheiner E, Biderman-Madar T, Katz M, et al. Higher rates of tachysystole among patients with clinically apparent uterine leiomyomas. Am J Obstet Gynecol. 2004;191:945.
19. Nguyen QH, Gruenewald SM. Sonographic appearance of a postpartum pyomyoma with gas production. J Clin Ultrasound. 2008;36:186.
20. Laubach M, Breugelmans M, Leyder M, et al. Nonsurgical treatment of pyomyoma in the postpartum period. Surg Infect (Larchmt). 2011;12:65.
21. Vergani P, Locatelli A, Ghidini A, et al. Large uterine leiomyomata and risk of cesarean delivery. Obstet Gynecol. 2007;109:410.
22. Michels KA, Velez Edwards DR, Baird DD, et al. Uterine leiomyomata and cesarean birth risk: a prospective cohort with standardized imaging. Ann Epidemiol. 2014;24:122.
23. 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:e0187821.
24. Mason TC, Adair J, Lee YC. Postpartum pyomyoma. J Natl Med Assoc. 2005;97:826.
25. Kobayashi F, Kondoh E, Hamanishi J, et al. Pyomayoma during pregnancy: a case report and review of the literature. J Obstet Gynaecol Res. 2013;39:383.
26. Lin YH, Hwang JL, Huang LW, Chen HJ. Pyomyoma after a cesarean section. Acta Obstet Gynecol Scand. 2002;81:571.
27. Wittich AC, Salminen ER, Yancey MK, Markenson GR. Myomectomy during early pregnancy. Mil Med. 2000;165:162.
28. Celik C, Acar A, Ciçek N, et al. Can myomectomy be performed during pregnancy? Gynecol Obstet Invest. 2002;53:79.
29. Vitale SG, Tropea A, Rossetti D, et al. Management of uterine leiomyomas in pregnancy: review of literature. Updates Surg. 2013;65:179.
30. Tower AM, Cronin B. Myomectomy after a vaginal delivery to treat postpartum hemorrhage resulting from an intracavitary leiomyoma. Obstet Gynecol. 2015;125:1110.
31. Kwon SY, Lee G, Kim YS. Management of severely painful uterine leiomyoma in a pregnant woman with epidural block using a subcutaneous injection port. Acta Obstet Gynecol Scand. 2014;93:839.
32. Moridaira T, Yamamoto G, Hiraishi M, et al. A case of continuous epidural anesthesia for pain relief in a pregnant woman with uterine myoma in the second trimester of pregnancy. Masui. 2013;62:1253 (in Japanes).
33. Ehigiegba AE, Ande AB, Ojobo SI. Myomectomy during cesarean section. Int J Gynaecol Obstet. 2001;75:21.
34. Pergialiotis V, Sinanidis I, Louloudis IE, et al. Perioperative Complications of Cesarean Delivery Myomectomy: A Meta-analysis. Obstet Gynecol. 2017;130:1295.
35. ACOG Committee Opinion No. 764: Medically Indicated Late-Preterm and Early-Term Deliveries. Obstet Gynecol. 2019;133:e151.

Авторы

Ю.Э. Доброхотова1, С.Ж. Данелян2, Е.И. Боровкова*1, Е.А. Нагайцева2, Д.Х. Сарахова2, Д.С. Селимшаева1, К.А. Боровская1

1 ФГАОУ ВО «Российский национальный исследовательский медицинский университет им. Н.И. Пирогова» Минздрава России, Москва, Россия;
2 ГБУЗ «Городская клиническая больница №40» Департамента здравоохранения г. Москвы, Москва, Россия
*Katyanikitina@mail.ru

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Iuliia E. Dobrokhotova1, Sonia Zh. Danelian2, Ekaterina I. Borovkova*1, Elena A. Nagaitseva2, Dzhamilia Kh. Sarakhova2, Dinara S. Selimshaeva1, Kseniia A. Borovskaia1

1 Pirogov Russian National Research Medical University, Moscow, Russia;
2 City Clinical Hospital №40, Moscow, Russia
*Katyanikitina@mail.ru

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