ULTRASOUND DIAGNOSIS OF UTERINE MYOMAS AND COMPLICATIONS IN PREGNANCY

Objective: To evaluate myomas for ultrasound-documented size, location , position, and relation to the placenta, and to relate these findings to complications during pregnancy, at delivery, and in the puerperium . Methods: Among 12,708 pregnant patients who had ultrasound scans, 49 2 had uterine myomas. Single myomas were found in 88% of cases and mul tiple myomas in 12%. The myomas were evaluated for size, number, posit ion, location, relationship to the placenta, and echogenic structure, and the outcome of pregnancy was compared to that of patients in the c ontrol group. Results: A statistically significant increased incidence of threatened abortion, threatened preterm delivery, abruptio placent ae, and pelvic pain was observed in patients with uterine myomas (P < .001). Abruptio placentae was particularly evident in women with myoma volumes greater than 200 cm3, submucosal location, or superimposition of the placenta. Pelvic pain was related to myoma volume greater than 200 cm3 and ultrasound findings of heterogeneous echo patterns and cy stic areas. Mode of delivery, abortion, preterm birth, premature ruptu re of membranes, and fetal growth did not seem to be affected by the p resence of myomas. Thirty-two women with uterine myomas were managed s urgically. Thirteen underwent myomectomy during pregnancy. Of these, e ight delivered at term and five delivered preterm after the 32nd week of gestation. None of the deliveries were associated with neonatal dea th. The other 19 patients had surgery at delivery. Nine myomectomies w ere performed at cesarean delivery. Of these, three were complicated b y severe hemorrhage necessitating hysterectomy. Another nine hysterect omies were performed during cesarean and one after vaginal delivery. C onclusions: In addition to myoma size, the ultrasound evaluation of pr egnant women with myomas should include position, location, relationsh ip to the placenta, and echogenic structure. These ultrasound findings make it possible to identify women at risk for myoma-related complica tions and could be useful in managing the pregnancy.