Removing fibroids can prevent recurrent miscarriage

Surgical removal of fibroids that distort the uterine cavity reduced the risk of second-trimester miscarriage to zero in a new study that also found solid evidence linking fibroids to recurrent miscarriage (ie, 3 or more consecutive miscarriages).

The study, which was published online September 28 in Human Reproduction, analyzed retrospective and prospective data from 966 women referred to a recurrent miscarriage clinic in Sheffield, United Kingdom. Researchers diagnosed fibroids in 79 women using combined transvaginal ultrasound and hysterosalpingography and removed uterine cavity-distorting (submucosal) fibroids from 25 women by hysteroscopy. Fifty-four women with nondistorting (intramural or subserosal) fibroids and a matched control group of 285 women with unexplained recurrent miscarriages had no intervention. Among the 25 women whose fibroids were removed, subsequent second-trimester miscarriage rates fell from 21.7% to 0%, (P<0.01) raising the live birth rate from 23.3% to 52%.

In addition, the study enabled researchers to calculate the prevalence of fibroids among women with recurrent miscarriages at 8.2% (79/966).

The 54 women with non-distorting fibroids achieved a live birth rate of 70.4% without intervention after referral to the clinic, compared with a 20.6% live birth rate before referral. The second-trimester miscarriage rate in this group dropped from 17.6% to 0%. These results were similar to results for the control group.

The researchers recommend offering hysteroscopic surgery to women with uterine-distorting fibroids who have suffered 1 or more second-trimester miscarriages but not to women with intramural or subserosal fibroids. A limitation of the study is lack of a control group for women who underwent surgery to remove fibroids, which precluded determining how the women would have fared without surgery.

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