Myoma in pregnancy

Abstract

Uterine myomas (leiomyomas or fibroids) are common benign tumors, arising from the smooth muscle of the uterus. The true prevalence of fibroids is unknown as there is no screening program for asymptomatic women, but the estimated prevalence of myomas is 30 % in all women, 20-40 % in reproductive aged women and 40-60 % of women by age 35 [1]. The risk of myoma increases significantly with increasing age, and by age 50, 70-80 % of women will have had a fibroid [2]. Prevalence is two to three times higher in black women [3]. Decreased incidence is observed with increased parity. This effect is further amplified with childbearing from age 25 to 29 [1]. Factors that alter estrogen levels also modify risk. Smoking, exercise, and lean body mass decrease the incidence, while obesity and early menarche increases the risk. Despite strong associations wiThestrogen, there is no observed effect with oral contraceptives (Fig. 15.1) [1, 3]. Myomas are typically classified as one of three types: subserous, intramural or submucous, determined by location relative to the myometrium. Further descriptors include pedunculated, for those attached by a stalk, or cervical, based on location (Fig. 15.2).