Fibroma and pregnancy: epidemiological, diagnostic, therapeutic and prognostic aspects about 133 cases at the gynecology-obstetrics department of the hospital institute of social hygiene of Dakar from january 1, 2019 to june 30, 2022

Abstract

Objectives: To determine the frequency of fibroid association with pregnancy, to establish the epidemiological profile of pregnant women with fibroids, to assess the maternal and perinatal prognosis and to specify the factors associated with the risk of maternal and perinatal complications at the maternity ward of the Institut d'Hygiène Sociale (IHS) hospital in Dakar. Patients and methods: This was a retrospective, descriptive and analytical study conducted over a period of 42 months and covering cases of fibroid association and pregnancy managed at the maternity ward of the IHS hospital Results: We recorded 133 cases of fibroids associated with pregnancy among 6621 parturients, representing a frequency of 2% of deliveries. The epidemiological profile of the patients was that of a woman aged 32 years on average, married (97%), primigravida (58.6%), nulliparous (68.4%) and with a history of myomectomy (4.5%). Mean gestational age at delivery was 35 SA, with extremes of 5 and 42 SA. We recorded 25.6% RPM, 8.3% breech presentation and 1.5% transverse presentation. RPM was recorded in 25.6%, breech presentation in 8.3% and transverse presentation in 1.5%. Caesarean section was the most frequent mode of delivery (83.3%), with indications dominated by acute non-reassuring fetal status (24.2%), and feto-pelvic disproportion (11.3%). The mean number of fibroids per patient was 2, with extremes of 1 and 8, and a mean size of 65 mm. The most frequent type of fibroid was type 6 (45.5%). Fibroids praevia accounted for 3%. Maternal complications were dominated by premature delivery (27.5%) and spontaneous miscarriage (11.3%). A multivariate analysis revealed that maternal complications were more frequent in patients aged between 21 and 30 (69.6%, p=0.015) and nulliparous women (60.4%, p=0.056). Perinatal complications were dominated by prematurity (27.5%) and intrauterine growth retardation (16.7%). Perinatal mortality was estimated at 60.3 per 1000 births. Conclusion: Fibroids and pregnancy are high-risk conditions for both mother and fetus. Delivery is usually by caesarean section. The most frequent maternal complication is premature delivery.