OBSTETRICAL COMPLICATIONS, FREQUENCY AND INDICATIONS OF CESAREAN-SECTIONS IN PATIENTS WITH UTERINE LEIOMYOMAS

An increasing percentage of patients with uterine leiomyomas was obser ved in the Department of Obstetrics, University of Freiburg, on compar ing the years 1970-79 (0.25 %) and 1980-89 (0.64 %). While first trime ster bleeding, pain and premature labour, being typical obstetrical co mplications, were encountered in a comparable frequency, atonic bleedi ng was observed more often during the nineteen-eighties. Pain and prem ature labour were often present, if the leiomyomas were large, irrespe ctive of both their number or localization. Atonic bleeding was observ ed more frequently, if large leiomyomas were present. A correlation be tween the presence of uterine leiomyomas and placental deficiency, pre mature birth, and EPH gestosis seems uncertain. The total complication rate among all pregnant patients with uterine leiomyomas was 65 % fro m 1980-89. The Caesarean section rate among patients with uterine leio myomas increased during the evaluated time span, and reached 51 % duri ng the 1980's, as compared to a general frequency of Caesarean section s of 19 % during the latter time period; this increase in frequency se ems to be rather in keeping with a generally increasing Caesarean sect ion rate as opposed to a changing indication for surgery in patients w ith myomas. The myomas themselves caused Caesarean sections in 50 % of cases, while in the remaining 50 % of patients, Caesarean sections we re performed for general obstetrical reasons. The probability to be de livered by Caesarean section was especially high amongst patients with multiple myomas or with an isthmic myoma. Our study supports a conser vative approach in the case of pregnancy and uterine leiomyomas.