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4092804 
Journal Article 
Does size matter? Fibroids and the pregnant uterus 
Spadola, A; Cleary-Goldman, J; Robinson, J 
2003 
Yes 
American Journal of Obstetrics & Gynecology
ISSN: 0002-9378
EISSN: 1097-6868 
DART/TER/4000148 
189 
6 Suppl 
English 
OBJECTIVE: To determine the significance of fibroid size assessed by prenatal ultrasound on obstetrical outcomes. STUDY DESIGN: We performed a retrospective chart review of singleton pregnancies with uterine fibroids identified from an obstetric ultrasound database from 1/99-12/02. Inclusion criteria included fetal viability, fibroids and gt; 3 cm, and gt; 13 weeks, and on-site delivery. Exclusion criteria included multiple gestation, fibroids and lt; 3 cm, uterine or fetal anomalies, elective termination, and ectopic pregnancy RESULTS: 1163 pregnancies were reviewed. For analysis we grouped patients with fibroids measuring 3-6 cm (N = 278) and and gt; 6 cm (N = 136). Mean patient age between groups was similar; however, there were 130 primigravidas in the small fibroid group vs 82 in the large fibroid group (47% vs 60%, P = .012). A subplacental fibroid was noted in 93 vs 66 (34% vs 49%, P = .003) and tumor previa occurred in 7 vs 28 (2.5% vs 21%, P and lt; .0001). Cesarean delivery (CD) occurred in 120 vs 75 cases (43% vs 55%, P = .027) complicated by classical incision in 2 vs 12 (0.7% vs 9%, P and lt; .0001) and subsequent hysterectomy in 0 vs 4 (0% vs 3%, P = .002). Compared with a control group of 125 unaffected pregnancies, the rate of CD for the and gt; 6 cm group was significantly higher (P = .013). No significant difference was found between controls and the 3-6 cm group (P = .513). The Table demonstrates differences in maternal complications. There was no significant difference in incidence of stillbirth or fetal growth restriction. Overall, the incidence of complications between the two groups was 21% vs 39% (P and lt; .0001). CONCLUSION: Fibroids and gt; 6 cm are associated with a higher likelihood of cesarean delivery and intrapartum complications, but not growth restriction or stillbirth. (Table: see text.)