Trends Of Uterine Fibroids During Pregnancy And Postpartum And Analysis Of Related Influencing Factors

Objective The change characteristics of uterine fibroids during pregnancy and postpartum were analyzed,and the related influencing factors were analyzed,in order to provide clinical reference for pregnant women with uterine fibroids on pregnancy choice and prenatal consultation.Methods Vaginal birth or caesarean were collected from Shenyang Women’s and Children’s Hospital from January 2020 to December 2020.The clinical data of 167 pregnant women who did not undergo hysteromyoma nucleation during the operation included: pregnancy and postpartum.The maximum diameter of uterine fibroids(gestation 6-8 weeks,gestation 11-14 weeks,gestation 22-25 weeks,gestation 33-36 weeks and 42-60 day after delivery,postpartum 4-6 months,postpartum 1 year),age,gestational times,parity,pre-pregnancy BMI,early pregnancy whether there is pregnancy history,gestational diabetes mellitus,placental location and fibroid location are the same,uterine fibroid type,initial size of uterine fibroids,the number of fibroids(single,multiple),delivery method(vaginal birth,caesarean),postpartum breastfeeding,breastfeeding time,postpartum menstruation time.Some parameters are defined as follows:(1)Duration of ultrasound examination during pregnancy and postpartum:T1= gestation 6-8 weeks;T2= gestation 11-14 weeks;T3= gestation 22-25 weeks;T4=gestation 33-36 weeks;T5=42-60 days after postpartum;T6= postpartum 4-6 months;T7=postpartum 1 year;(2)The maximum diameter of uterine fibroids during pregnancy and postpartum was recorded as(D),and the change of fibroid diameter was(CD)= the latter diameter-the former diameter,CD1-2=D2-D1,CD2-3=D3-D2,CD3-4=D4-D3,CD4-5=D5-D4,CD5-6=D6-D5,CD6-7=D7-D6,CD1-4=D4-D1,CD1-7=D7-D1;(3)Fibroid growth rate(G)= the latter diameter-the former diameter/the former diameter×100%.G1-2=D2-D1/D1×100%,G2-3=D3-D2/D2×100%,G3-4=D4-D3/D3×100%,G4-5=D5-D4/D4×100%,G5-6=D6-D5/D5×100%,G6-7=D7-D6/D6×100%,G1-4=D4-D1/D1×100%,G1-7=D7-D1/D1×100%;Ultrasound equipment: Ultrasound high-resolution devices(Voluson E8,GE,Voluson E10,GE),abdominal probes(C1-5-D,RAB6-D),and cathodic probes(RIC-9-D)were all examined by qualified ultrasound doctors.Statistical method: SPSS25.0 software was used for statistical analysis of the data.Measurement data were expressed as mean ± standard deviation(x±s)and percentage(%).Variance test was used for comparison between groups.Counting data is expressed as a percentage(%);The influential factors of the diameter change of uterine fibroids during pregnancy and postpartum were analyzed by Logistic binary regression,and the OR value was calculated.P < 0.05 was considered statistically significant.Results1.The analysis of the trend of the maximum diameter of uterine fibroids during pregnancy and postpartum showed that the maximum diameter of uterin e fibroids from T1-T3 showed an increasing trend.T3-T4 showed no significant change in the maximum diameter of uterine fibroids.The maximum diameter of T4-T7 showed a decreasing trend.2.The growth rate of uterine fibroids during pregnancy and postpartum was 0.67± 0.76% for G1-4 and-30.34% ± 52.21% for G1-7.In general,the diameter of uterine fibroids increased in the late trimester compared with that in the early trimester,but decreased in the postpartum compared with that in the early trimester.3.There was no correlation between age,gestational times,parity,pre-pregnancy BMI,early pregnancy whether there is pregnancy history,gestational diabetes mellitus,placental location and fibroid location are the same,uterine fibroid type,initial size of uterine fibroids,the number of fibroids and CD1-2,CD2-3 and CD3-4(P>0.05).age,gestational times,parity,pre-pregnancy BMI,early pregnancy whether there is pregnancy history,gestational diabetes mellitus,placental location and fibroid location are the same,uterine fibroid type,initial size of uterine fibroids,the number of fibroids,delivery method,postpartum breastfeeding,breastfeeding time,postpartum menstruation time and CD4-5,CD5-6,CD6-7 were not correlated(P>0.05).Initial fibroid size and occurrence were negatively correlated with the change of CD1-4fibroids,and were protective factors(P=0.028,OR 0.672,95%CI 0.471 ~ 0.958,P=0.01,OR 0.188,95%CI 0.053-0.667),gestational diabetes mellitus was positively correlated with risk factors(P=0.041,OR 2.777,95%CI 1.042 ~ 7.397);Lactation time was negatively correlated with the change of CD1-7 fibroids,and was a protective factor(P=0.046,OR 0.904,95%CI 0.819~0.998).Conclusion Uterine fibroid diameter does not change linearly during pregnancy,but parabola.The overall change trend of uterine fibroid diameter during pregnancy and postpartum was inverted "U" shape.That is,uterine fibroids do not continue to grow during pregnancy,and there is no significant change between the second and third trimester,and uterine fibroids shrink significantly 1 year after delivery.Gestational diabetes mellitus,stage and initial fibroid size were the factors affecting the change of uterine fibroids during pregnancy.The duration of lactation is a factor affecting the change of postpartum uterine fibroids.However,this only establishes the correlation between risk factors and the changes of fibroids during pregnancy and postpartum.The changes of the uterus before pregnancy are not clear,because every woman is an independent individual and the fibroids are also dynamically changing.Therefore,clinicians need to develop individualized plans for different patients.