妊娠合并子宫肌瘤患者临床特征与分娩结局的关系OA

Objectives:To investigate the relationship between the clinical characteristics(FIGO classification,size,and number)of pregnant women with uterine fibroids and postpartum hemorrhage and delivery modes,providing a basis for identifying high-risk populations and guiding clinical delivery decisions. Methods:A retrospective cohort study was conducted on 618 pregnant women with uterine fibroids who delivered at Xuanwu Hospital of Capital Medical University from January 2022 to April 2025.The primary outcome measure is postpartum hemorrhage,while secondary measures include gestational age,mode of delivery,and newborn birth weight.According to the ultrasound and intraoperative exploration results,the fibroids were grouped and analyzed based on their location(submucosal group,Type 3 fibroids,intramural/subserosal group,cervical/other group),maximum diameter(＜4 cm,4 to＜7 cm,7 to＜10 cm,≥10 cm),and number(single or multiple)according to the FIGO classification of fibroids. Results:(1)Fibroid location(FIGO classification):Significant differences were found in the delivery modes(x2=42.158,P＜0.001)and the incidence of postpartum hemorrhage(x2=15.224,P=0.002)among different FIGO types;the cesarean section rate was the highest in the cervix/other group(89.3％),and the incidence of postpartum hemorrhage was higher in the cervix/other group and type 3 group(35.7％and 34.2％,respectively).(2)Fibroid size:Significant differences were found in delivery modes(x2=26.417,P=0.001)and postpartum hemorrhage volume(H=18.432,P＜0.001)among different size groups;the group with fibroids ≥ 10 cm had the highest cesarean section rate(91.3％),and postpartum hemorrhage increased with fibroid enlargement.(3)Fibroid number:Compared with the single fibroid group,the multiple fibroids group showed significantly higher rates of cesarean section(78.4％vs.48.9％,P＜0.001),postpartum hemorrhage volume[450.0(320.0,600.0)ml vs.310.0(200.0,420.0)ml,P＜0.001],and preterm birth(14.4％vs.6.1％,P=0.004). Conclusions:FIGO classification,size,and number of uterine fibroids are closely associated with adverse delivery outcomes.Type 3 fibroids,cervical/other special locations,larger diameters(especially ≥10 cm)and multiple fibroids are closely related to adverse delivery outcomes such as increased postpartum hemorrhage and cesarean section rates.