Use of pre-operative imaging for symptomatic uterine myomas during pregnancy: a case report and a systematic literature review.

Autor: Valenti, Gaetano, Milone, Pietro, D'Amico, Serena, Caldaci, Lisa Maria Grazia, Vitagliano, Amerigo, Sapia, Fabrizio, Fichera, Michele
Předmět:
Zdroj: Archives of Gynecology & Obstetrics; Jan2019, Vol. 299 Issue 1, p13-33, 21p, 5 Diagrams, 2 Charts
Abstrakt: Purpose: Uterine fibroids (UFs) occur in 10% of pregnancies and may lead to severe maternal-fetal complications, mainly depending on UFs characteristics and the distance to the uterine cavity (UC). When symptomatic, UFs are managed medically. Nevertheless, in about 2% of cases, surgery becomes necessary. Entry into the UC should be avoided during myomectomy. Consequentially, pre-operative assessment of this risk could be beneficial. Ultrasonography (US) represents the gold standard for UFs assessment; however, scarce evidence has been produced to assess the role of magnetic resonance imaging (MRI). The aim of the present study was to summarize current evidence about the pre-operative use of imaging techniques for UFs during pregnancy.Methods: A systematic research of the literature was conducted in Scopus, PubMed/MEDLINE, ScienceDirect and the Cochrane Library, including case reports and case series. A case report was also discussed. We collected data regarding patients, imaging assessment, UFs characteristics, surgical information, timing and modality of delivery.Results: According to our search strategy, 66 articles were selected and 210 patients were included. US assessment was reported in 36 (17%) cases. MRI was reported in 10 (4.7%) cases. Only in one case, MRI was used to measure the distance between UFs and UC.Conclusion: US allows an adequate pre-operative evaluation of anterior, submucosal or pedunculated symptomatic UFs in pregnancy. However, compared to US, MRI may provide a more accurate evaluation of multiple, large, intramural or posterior UFs and could measure the distance between UFs and UC more accurately. [ABSTRACT FROM AUTHOR]
Databáze: Complementary Index