Prise en charge des myomes utérins durant la grossesse

Conclusion La présence d’un utérus myomateux est une situation obstétricale dont les complications sont rares et probablement surévaluées. La myomectomie en cours de césarienne ne semble pas associée à une augmentation de la morbidité maternelle à court terme. Son intérêt à long terme est insuffisamment évalué. Objective To assess the impact of myomas on pregnancy and discuss the role of myomectomy during cesarean section. Methods Databases PubMed, Medline and Cochrane were searched until 30 June 2015. Results The most commonly reported obstetric complications relative to fibroids are: increased rate of spontaneous miscarriage in women with submucosal or intramural fibroids, pain, placentation disorders and malpresentation. A higher cesarean section rate is found among pregnant women with fibroids. The most common postpartum complication is postpartum haemorrhage. For years, risk of haemorrhage led caregivers not to practice myomectomy during cesarean section. Current data are rather reassuring. No study shows significant hemorrhage differences between myomectomy during cesarean section and cesarean section alone or myomectomy alone. The long-term morbidity of myomectomy during cesarean section is not enough studied but does not appear higher than expected for fertility and complications during pregnancy. Therefore, myomectomy during cesarean section is not currently recommended by learned societies. Conclusion Women with fibroids is a common obstet...
Source: Gynecologie Obstetrique and Fertilite - Category: OBGYN Source Type: research