In a recent study, larger fibroid sizes and location in the lower uterine segment or cervix were associated with greater odds of post partum hemorrhage requiring packed red blood cell transfusion.
The size of fibroids and location in the lower uterine segment or cervix are associated with increased risks of postpartum hemorrhage (PPH) and PPH requiring packed red blood cell transfusion (PPH+PRBC), while the number of fibroids is not associated, according to a recent study published in The American Journal of Obstetrics and Gynecology.
The study was conducted to determine if large fibroids, especially those greater than 10 cm, led to increased risk of PPH+PRBC, as there is limited data on how fibroid characteristics impact PPH. Participants included patients with singleton pregnancies who received a prenatal ultrasound at 18 weeks or more gestation.
Patients delivered at 1 of 7 hospitals in New York between 2019 and 2022. For patients with multiple deliveries, only the first was used in the analysis. Maternal-Fetal Medicine attending physicians reviewed ultrasound examinations performed by Registered Diagnostic Medical Sonographers.
Fibroid size, location, and number were recorded, with size categories including small at under 5 cm, medium at 5 to 10 cm, and large at 10 cm. PPH+PRBC incidence was recorded as the primary outcome of the study.
The association between fibroid characteristics and PPH+PRBC was determined through multiple logistic regression. Adjustments were made for hemoglobin level on admission for delivery and history of uterine surgery.
There were 4421 patients in the analysis, 4.5% of which presented with PPH+PRBC. Of presenting fibroids, 64.9% were small, 30.5% medium, and 4.7% large. Small fibroids were associated with PPH+PRBC in 3.5% of cases, medium in 6.1%, and large in 9.7%.
A single documented fibroid was seen in 61.7% of patients, and fibroids located in the lower uterine segment or cervix in 16%. Patients with medium sized fibroids were 1.65 times more likely to receive PPH+PRBC than those with small fibroids, while patients with large fibroids were 2.44 times more likely than those with small fibroids.
The odds of PPH+PRBC were 1.49 times greater in patients with fibroids located in the lower uterine segment or cervix compared to those with other uterine locations. However, the number of fibroids present did not impact the odds of PPH+PRBC.
These results indicate a need for fibroid examinations through prenatal ultrasound, with consideration about counseling related to hemorrhage risk for patients with medium or large sized fibroids or those with fibroids located in the lower uterine segment or cervix.
Yaghoubian YC, Prasannan L, Alvarez A, Gerber RP, Galagedera N, Blitz MJ.Fibroid size and number and risk ofpost partumhemorrhage. American Journal of Obstetrics and Gynecology. 2023. doi:10.1016/j.ajog.2023.05.001