Pregnancy complicated by uterine leiomyomas is a common obstetric condition, with postpartum hemorrhage (PPH) being a critical complication that warrants vigilance. Uterine leiomyomas are associated with a higher incidence of PPH, which often presents with greater severity and clinical complexity, due to mechanisms such as altered uterine cavity configuration, impaired uterine contractility, and abnormal placental implantation. This review focuses on the incidence, pathogenesis, management strategies, and pregnancy outcomes of PPH in patients with pregnancy complicated by uterine leiomyomas, aiming to improve maternal and neonatal safety and optimize pregnancy outcomes.
In recent years, the proportion of advanced maternal age pregnancies has increased, accompanied by a rising detection rate of uterine fibroids during pregnancy. Current evidence suggests an association between uterine fibroids complicating pregnancy and an elevated risk of miscarriage, with fibroid location and number potentially serving as key determinants. The underlying mechanisms may involve reduced endometrial receptivity secondary to alterations in uterine cavity anatomy, local hemodynamic disturbances such as impaired perfusion, and dysregulation of the inflammatory and immune microenvironment. Clinically, preconception evaluation should incorporate fibroid classification, size, number, and their impact on uterine cavity configuration. Submucosal fibroids that distort the uterine cavity may be considered for removal prior to conception. During pregnancy, women with uterine fibroids should be managed as high-risk, with serial surveillance and timely management of related complications. This review aims to synthesize the most up-to-date evidence regarding the relationship between uterine fibroids during pregnancy and miscarriage risk, elucidate potential mechanisms, and propose individualized preconception and antenatal management strategies based on fibroid type, size, and number, thereby informing clinical risk assessment and standardized prevention and management.
Red degeneration of uterine leiomyomas during pregnancy is a distinct emergency occurring in the second and third trimesters, which may lead to various adverse maternal and fetal outcomes in severe cases. It is primarily characterized by acute abdominal pain and fever. Due to its atypical presentation, differentiation from various acute abdominal conditions is required. A comprehensive evaluation of the red degeneration is essential, involving dynamic assessment and stratified management based on gestational age, fibroid characteristics (e.g., size, number, location), clinical symptoms, and the patient′s overall condition. Conservative treatment should be the first-line approach. If conservative treatment proves ineffective, myomectomy may be considered. The feasibility of vaginal delivery should be thoroughly assessed, as uterine leiomyomas are not an absolute indication for cesarean section. For patients eligible for vaginal delivery, close monitoring during labor is necessary, with timely intervention when indicated to reduce adverse maternal and neonatal outcomes.
Degeneration of uterine fibroids is a frequent complication in pregnancy, with red degeneration being the most prevalent form. In contrast, sarcomatous transformation of uterine fibroids during pregnancy is exceedingly rare. Fibroids exhibiting sarcomatous change are highly malignant and carry a significant risk of metastasis. When such transformation occurs during pregnancy, clinical manifestations are often nonspecific and may include rapid enlargement of the uterine mass, abdominal pain, and vaginal bleeding.Magnetic resonance imaging serves as the primary auxiliary diagnostic tool. Although miscarriage and preterm delivery are major obstetric complications of sarcomatous degeneration, most patients diagnosed in the late third trimester can achieve favorable fetal outcomes. It is very difficult to diagnose sarcomatous transformation of uterine fibroids during pregnancy, and the diagnosis is ofter confirmed only after cesarean section or vaginal delivery. Prompt surgical intervention for complete tumor resection, along with adjuvant radiotherapy or chemotherapy when indicated, is critical to optimizing maternal prognosis.
Adenomyosis is a benign condition characterized by the presence of endometrial glands and stroma with the myometrium.It not only impairs fertility but also significantly increases the risk of adverse pregnancy outcomes. By disrupting the integrity of the endometrial-myometrial junction and inducing chronic inflammation and fibrotic remodeling, adenomyosis exerts multidimensional effects on embryo implantation, placental development, and uterine contractile function. In early pregnancy, adenomyosis may impair endometrial receptivity and alter the local immune microenvironment, thereby significantly increasing the risk of pregnancy loss. During the second and third trimesters, uterine structural abnormalities and sustained inflammatory activation contribute to higher rates of preterm birth, placental abnormalities and hypertensive disorders of pregnancy, particularly in women with diffuse adenomyosis. During labor and the postpartum period, impaired myometrial contractility and placental complications further increase the risks of postpartum hemorrhage and adverse neonatal outcomes. This review systematically summarizes the associations between adenomyosis and adverse pregnancy outcomes and highlights the need to recognize adenomyosis as a high-risk pregnancy condition, which requires stratified risk assessment systems, dynamic monitoring and individualized management to improve maternal and neonatal outcomes.
Uterine fibroids are the most common benign pelvic tumors in women of reproductive age. The intricate relationship between fibroids and fertility, along with their potential effects on pregnancy outcomes, represents a significant intersection in reproductive medicine and obstetrics. For patients desiring future fertility, myomectomy not only alleviates symptoms but also serves as a key intervention to optimize the chances of successful pregnancy. However, while preconception myomectomy removes the lesions, it simultaneously alters uterine anatomy and compromises myometrial integrity, thereby influencing subsequent pregnancy, delivery, and perinatal outcomes. This article reviews pregnancy outcomes following myomectomy, discussing the choice between laparoscopic and open surgical approaches, the optimal interval to conception after surgery, prenatal surveillance, mode of delivery, and the prevention and management of potential complications. The goal is to establish a comprehensive clinical management framework spanning from preoperative evaluation to postpartum follow-up.
The choice of preconception treatment for uterine fibroids closely correlates with pregnancy outcomes. High-intensity focused ultrasound (HIFU) is an emerging minimally invasive therapy, which has attracted increasing attention. This review summarizes the research advances regarding the indications for HIFU in the treatment of uterine fibroids, the optimal timing of conception after treatment, pregnancy outcomes, and delivery-related considerations, aiming to provide evidence-based references for clinical practice.
To investigate the perinatal management and maternal and neonatal outcomes of 14 cases of delayed interval delivery in multiple pregnancies.
Methods
A retrospective analysis was conducted on 14 cases of multiple pregnancies that underwent delayed interval delivery at our hospital from 2017 to 2024. Data collected included gestational age at delivery, delivery interval, perinatal management, and maternal and neonatal outcomes.
Results
Among the 14 cases, 12 were conceived via in vitro fertilization-embryo transfer, and 2 via ovulation induction with timed intercourse. There were 12 twin pregnancies and 2 triplet pregnancies. The mean gestational age at delivery of the first fetus was 21+ 2 weeks, the mean delayed interval for the remaining fetus(es) was 47.42 days (2-127 days), and the mean gestational age at delivery of the last fetus(es) was 28+ 6 weeks. A total of 13 live infants were delivered, with a mean birth weight of 1 531.53 g (800-3 090 g). Among these, 12 newborns were transferred to the neonatal intensive care unit (NICU) after delivery, and 1 was transferred to the NICU on due to neonatal jaundice three days after birth. The mean length of NICU stay was 45.85 days (1-89 days). There were 12 vaginal deliveries, including 3 miscarriages, and 2 cesarean deliveries. All patients received prophylactic antibiotics and uterine contraction inhibitors; none underwent cervical cerclage. Placental pathology was available for 10 patients, revealing 1 case of placental abruption, 8 cases of stage Ⅰ-Ⅱ chorioamnionitis, and 2 cases with no inflammatory changes.
Conclusions
Delayed interval delivery is a specialized management strategy for multiple pregnancies. Its successful implementation improves the survival rate of the remaining fetus(es), reduces neonatal mortality, and contributes to better neonatal outcomes.
