Vіsnik Naukovih Doslіdžen' (Aug 2017)
PREDICTION OF RECURRENCE OF UTERINE FIBROIDS DURING PREGNANCY
Abstract
Myoma of the uterus occurs in 15–45 % of women of reproductive age, thus occupying the second place in the structure of gynecological pathology. According to A. L. Karyakina, the main risk factors for uterine fibroids are women over 30, concomitant gynecological diseases, hypermenstrual syndrome, more than 2 abortions in anamnesis. The aim of the study – to develop growth model of fibroids relapse during pregnancy. Materials and Methods. Research was developed at the Regional Perinatal Center (Odesa). There were analyzed 267 case histories of women giving birth, matched birth dates in 2007 and 2016. All these women had verified uterine fibroids at the pregravid stage, deleted by conservative myomectomy. There were evaluated the results of ultrasound test performed during pregnancy, with appropriate documentary evidence. There was taken into account the number of myomatic nodes before pregnancy, their size during pregnancy. Extent of uterine fibroids was determined based on ultrasonographic measurements for the ellipsoid formula: V=0.52 х a х b х c, where a – height, b – width, c – thickness node, 0.52 = π/2x3. Statistical analysis was performed using regression and multivariate analysis using software Statistica 10.0 (Dell StatSoft Inc., USA). Results and Discussion. According to a retrospective analysis the average age of women undergoing surgery for uterine fibroids was 33.7±2.2 years. Recurrence of fibroids appeared in 89 (33.3 %). Number of myoma nodules detected during pregnancy was averaged as 1.8±0.2. Thus the average size of units comprised 6.3±0.2 mm x 4.2±0.1 mm x 4.4±0.1 mm, which corresponds to the average volume of 0.49±0.02 cm3. In 49 (55.1 %) of pregnant women with recurrent uterine during the second trimester of myoma nodes was an increase in average 28.6±1.3 %. In developing the model for calculating the risk of relapse, we considered data on the hormonal profile of women, disease duration, presence of previous pregnancies, ultrasound data, including doplerometric characteristics, and the results of “triple” test. After the calculations obtained by the following equation: 𝑋𝑋= 𝑒𝑒𝑞𝑞 1+𝑒𝑒𝑞𝑞 , where q = 6.6–0.3 A–0.5 LV–1.5 S–0.9 E + 0.6 PL, where A – age LV – linear velocity of blood flow in the uterine arteries S – sum size of nodules E – ratio of estriol rate and its maximum reference level, PL – ratio of placentary lactogen eandits maximum reference level. Conclusions. The most important factors of recurrence of fibroids during pregnancy is the age of the woman, the linear velocity of blood flow in the uterine arteries, the size of fibroids, secretion levels of estriol and placental lactogen. Designed prediction algorithm allows determining the risk of recurrence of fibroids during pregnancy with an accuracy of 0.94.
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