LEIOMYOMA AND REPRODUCTIVE FUNCTION. FRONTIER OF REPRODUCTOLOGY AND MODERN OBSTETRICS

Abstract

The effect of uterine fibroids on fertility is complex and involves numerous mechanisms from the direct mechanical effect of tumor volume on the transport and implantation of germ cells, the effect on the uterine vascular system and on the processes of microcirculation of PM tissue induction of pro-inflammatory cytokines and the effect on gene expression (HOXA10, HOXA11, LIF, IL11, BMPR2, BTEB1, ITGB3, etc.) during the "implantation window".

The aim – to assess the implementation of reproductive function in women with uterine leiomyoma

Material and Methods. The study was performed on the basis of KNP "Regional Perinatal Center" and KNP "City Maternity Hospital No. 5" during 2016–2020. All of them had reproductive intentions and an unchanged ovarian-menstrual cycle after treatment. The mean age of women was 34.9±0.4 years. As a control, 30 pregnant women of the same age were examined, who at the time of registration did not have significant somatic and gynecological pathology.

The frequency of spontaneous pregnancies in operated women, features of pregnancy (frequency of threats of abortion, cases of ZVUR, complications of pregnancy and childbirth) were evaluated. Ultrasound monitoring was performed during pregnancy. The follow-up period ranged from 2 to 5 years (Me=3.5).

Results. Planned myomectomy restores fertile function in 46.7 % of women with LM. During pregnancy, residual myomas in 58.1 % of women were stable in size, in 23.3 % there was an increase in the size of the LM, in 18.6 % of pregnant women the size of the nodes decreased. Failure of the scar on the uterus after CME was found in 11.6 % of pregnant women. In pregnant women with a scar on the uterus and residual fibroids of small size are more likely to register cases of threat of miscarriage. In 18 (41.9 %) women of the main group and 5 (16.7 %) control resorted to operative delivery, in the remaining births occurred per vias naturales.