Abstract：
OBJECTIVE: Uterine fibroids increase the risk of preterm birth. The current study highlights uterine fibroid necrosis as a possible cause of (extreme) preterm birth.
METHODS: Retrospective cohort study in one Dutch academic hospital. Cases were selected from the 526 participants of the MyoFert study (Netherlands Trial Register, NL7990), which included patients who presented between 2004 and 2018 and were between the age of 18 and 45 years at the time of diagnosis of uterine fibroids. Of these participants, 414 women became pregnant. A retrospective chart review of the first pregnancies was performed. The main outcomes were (imminent) preterm birth and signs of fibroid necrosis on ultrasound. In women with signs of fibroid necrosis, the following data were collected systematically: fibroid characteristics, clinical presentation, pregnancy outcome, and postpartum period.
RESULTS: In total, 66 women had a preterm birth (16 %, 66/414), of which 25 pregnancies ended between 16 and <24 weeks (38 %, 25/66) and 41 pregnancies ended between 24 and <37 weeks of gestation (62 %, 41/66). Of all women with preterm birth and available ultrasound images, 15 % (7/48) had fibroid necrosis at the time of labour. These seven patients, supplemented with three patients with fibroid necrosis during their first pregnancy and at least one episode of imminent preterm birth, are described in more detail. In these ten patients, the fibroids increased substantially in size during the first and second trimester, leading to severe abdominal pain in all patients and hospital admission in seven patients. Ultrasound examination of the fibroids showed heterogenic changes and focal transonic areas in the fibroid, which are characteristics that indicate fibroid necrosis. In four patients, myomectomy was performed and necrosis was confirmed histologically.
CONCLUSIONS: Fibroid necrosis during pregnancy is likely associated with (imminent) preterm birth. Clinicians are advised to structurally evaluate the myometrium in pregnancy, specifically in women presenting with abdominal pain in the second trimester.
METHODS: Retrospective cohort study in one Dutch academic hospital. Cases were selected from the 526 participants of the MyoFert study (Netherlands Trial Register, NL7990), which included patients who presented between 2004 and 2018 and were between the age of 18 and 45 years at the time of diagnosis of uterine fibroids. Of these participants, 414 women became pregnant. A retrospective chart review of the first pregnancies was performed. The main outcomes were (imminent) preterm birth and signs of fibroid necrosis on ultrasound. In women with signs of fibroid necrosis, the following data were collected systematically: fibroid characteristics, clinical presentation, pregnancy outcome, and postpartum period.
RESULTS: In total, 66 women had a preterm birth (16 %, 66/414), of which 25 pregnancies ended between 16 and <24 weeks (38 %, 25/66) and 41 pregnancies ended between 24 and <37 weeks of gestation (62 %, 41/66). Of all women with preterm birth and available ultrasound images, 15 % (7/48) had fibroid necrosis at the time of labour. These seven patients, supplemented with three patients with fibroid necrosis during their first pregnancy and at least one episode of imminent preterm birth, are described in more detail. In these ten patients, the fibroids increased substantially in size during the first and second trimester, leading to severe abdominal pain in all patients and hospital admission in seven patients. Ultrasound examination of the fibroids showed heterogenic changes and focal transonic areas in the fibroid, which are characteristics that indicate fibroid necrosis. In four patients, myomectomy was performed and necrosis was confirmed histologically.
CONCLUSIONS: Fibroid necrosis during pregnancy is likely associated with (imminent) preterm birth. Clinicians are advised to structurally evaluate the myometrium in pregnancy, specifically in women presenting with abdominal pain in the second trimester.
摘要：
目的：子宫肌瘤增加早产风险。目前的研究强调子宫肌瘤坏死是（极端）早产的可能原因。
方法：在一家荷兰学术医院进行回顾性队列研究。病例是从MyoFert研究的526名参与者中选出的(荷兰试验登记册，NL7990),其中包括2004年至2018年期间就诊的患者,诊断为子宫肌瘤时年龄在18岁至45岁之间.在这些参与者中,414名妇女怀孕了。对首次妊娠进行了回顾性图表回顾。主要结果是（即将发生的）早产和超声检查显示的纤维瘤坏死迹象。在有纤维样坏死迹象的女性中，系统地收集了以下数据：纤维瘤特征，临床表现,妊娠结局,和产后。
结果：总计，66名妇女早产（16%，66/414)，其中25例怀孕在16到<24周之间结束(38%，25/66）和41例怀孕在妊娠24至<37周之间结束（62％，41/66)。在所有早产和可用超声图像的妇女中，15％（7/48）在分娩时出现纤维样坏死。这七个病人,补充了三名在第一次怀孕期间患有纤维瘤坏死的患者和至少一次即将发生早产的患者，更详细地描述了。在这十位患者中，在妊娠早期和中期，肌瘤的大小显著增加，导致所有患者严重腹痛，7例患者入院。超声检查显示肌瘤异源性改变和局灶性跨音速区，这是表明纤维瘤坏死的特征。在四名患者中，行子宫肌瘤切除术，组织学证实坏死。
结论：妊娠期间的纤维样坏死可能与（即将发生的）早产有关。建议临床医生在结构上评估妊娠子宫肌层，特别是在妊娠中期出现腹痛的女性中。
方法：在一家荷兰学术医院进行回顾性队列研究。病例是从MyoFert研究的526名参与者中选出的(荷兰试验登记册，NL7990),其中包括2004年至2018年期间就诊的患者,诊断为子宫肌瘤时年龄在18岁至45岁之间.在这些参与者中,414名妇女怀孕了。对首次妊娠进行了回顾性图表回顾。主要结果是（即将发生的）早产和超声检查显示的纤维瘤坏死迹象。在有纤维样坏死迹象的女性中，系统地收集了以下数据：纤维瘤特征，临床表现,妊娠结局,和产后。
结果：总计，66名妇女早产（16%，66/414)，其中25例怀孕在16到<24周之间结束(38%，25/66）和41例怀孕在妊娠24至<37周之间结束（62％，41/66)。在所有早产和可用超声图像的妇女中，15％（7/48）在分娩时出现纤维样坏死。这七个病人,补充了三名在第一次怀孕期间患有纤维瘤坏死的患者和至少一次即将发生早产的患者，更详细地描述了。在这十位患者中，在妊娠早期和中期，肌瘤的大小显著增加，导致所有患者严重腹痛，7例患者入院。超声检查显示肌瘤异源性改变和局灶性跨音速区，这是表明纤维瘤坏死的特征。在四名患者中，行子宫肌瘤切除术，组织学证实坏死。
结论：妊娠期间的纤维样坏死可能与（即将发生的）早产有关。建议临床医生在结构上评估妊娠子宫肌层，特别是在妊娠中期出现腹痛的女性中。
