Miomectomía en embarazo temprano

[Miomectomy in early pregnancy]

Edgar Rodolfo Herrerarte Méndez1, María Dolores Molina Rodríguez2

1. Programa de Educación continua en Ciencias de la Salud,Universidad de San Carlos, Guatemala; 2. Clínica Oncológica de la Mujer, Hospital El Pilar, Guatemala..

Publicado: 2022-01-05

Descargas

Resumen

Los miomas o leiomiomas son tumores benignos monoclonales que histológicamente surgen de la proliferación del músculo liso y tejido conectivo del útero. Son de crecimiento lento y la degeneración maligna es menor a 1% y tan bajo como 0.2%. La prevalencia mundial varia de 5-21%, aumenta con la edad; 1.8% en mujeres de 20-29 años y 14.1% en mayores de 40 años.
Se reporta reducción del embarazo clínico en pacientes con miomatosis uterina mayor de 4 cms (29 vs 52%, p=0.025), comparadas en mujeres sin miomatosis uterina. Si se logra el embarazo como tal, los miomas durante el embarazo pueden causar: incremento en la tasa de abortos espontáneos (por distorsión de la cavidad uterina), contracciones prematuras, ruptura prematura de membranas, placenta previa, desprendimiento prematuro de placenta, presentación fetal anormal, o hemorragia post parto y aumento en el índice de cesáreas. Describimos el caso clínico de paciente femenina de 36 años, primigesta, con historia de infertilidad primaria y diagnóstico de miomatosis uterina de grandes elementos con embarazo de 11 semanas, en quien se decide miomectomía durante embarazo por presentar varios cuadros clínicos de amenaza de aborto y dolor pélvico constantemente, así como dificultad respiratoria por volumen uterino, que evoluciona satisfactoriamente y en quien se resuelve embarazo por medio de una cesárea programada mas histerectomía, obteniéndose recién nacida femenina a término.


Abstract

Myomas or leiomyomas are benign monoclonal tumors that histologically arise from proliferation of smooth muscle and connective tissue of the uterus. They are slow growing and malignant degeneration is less than 1% and as low as 0.2%. Worldwide prevalence varies from 5-21%, increasing with age; 1.8% in women aged 20-29 years and 14.1% in women over 40 years.
A reduction in clinical pregnancy is reported in patients with uterine myomatosis greater than 4 cms (29 vs. 52%, p=0.025), compared to women without uterine myomatosis. If pregnancy is achieved as such, fibroids during pregnancy may cause: increased rate of miscarriage (due to distortion of the uterine cavity), premature contractions, premature rupture of membranes, placenta previa, placental abruption, abnormal fetal presentation, or postpartum hemorrhage and increased rate of cesarean section. We describe the clinical case of a 36-year-old female patient, primigravida, with a history of primary infertility and diagnosis of uterine myomatosis of large elements with a pregnancy of 11 weeks, in whom myomectomy was decided during pregnancy because she presented several clinical symptoms of threatened abortion and constant pelvic pain, as well as respiratory difficulty due to uterine volume, which evolved satisfactorily and in whom pregnancy was resolved by means of a programmed cesarean section plus hysterectomy, obtaining a female newborn at term.

Citas

[1] Amy Mackey, Joshua I. Ng, Jason Core, et al. Procedures and Instruments Three-Dimensional-Printed Uterine Model for Surgical Planning of a Cesarean Delivery Complicated by Multiple Myomas. Obstetrics & Gynecology 2019;133(4): 720-724. URL: https://doi.org/10.1097/AOG.0000000000003107

[2] Vargas-Hernández VM, Vargas-Aguilar VM, Tovar-Rodríguez JM, et al. Leiomiomatosis uterina. Aspectos epidemiológicos, fisiopatogénicos, reproductivos, clínicos y terapéuticos. Rev Hosp Juárez México. 2013;80(3):173-182.

[3] Sarah-Jane L, Best S, Kumar S, The impact of fibroid characteristics on pregnancy outcome. American Journal of Obstetrics and Gynecology. 2014;211(4):395 URL: https://doi.org/10.1016/j.ajog.2014.03.066

[4] Egbe, T.O., Badjang, T.G., Tchounzou, R. et al. Uterine fibroids in pregnancy: prevalence, clinical presentation, associated factors and outcomes at the Regional Hospitals, Cameroon: a cross-sectional study. BMC Res Notes 11, 889 (2018) URL: https://doi.org/10.1186/s13104-018-4007-0

[5] Abdullah R, Massey I, Zhao Y, Et al. Pregnancy-related leiomyoma growth and pregnancy complications in pregnant women after IVF. International Journal Clinical Experimental Medicine, 2020;13(5):3513-3521.

[6] Stewart EA, Cookson CL, Gandolfo RA, Schulze-Rath R. Epidemiology of uterine fibroids: a systematic review. BJOG 2017;124:1501-1512. URL: https://doi.org/10.1111/1471-0528.14640

[7] Shavell VI, Thakur M, Sawant A, Kruger ML, Jones TB, Singh M, Puscheck EE, Diamond MP. Adverse obstetric outcomes associated with sonographically identified large uterine fibroids. Fertil Steril. 2012 Jan;97(1):107-10. URL: https://doi.org/10.1016/j.fertnstert.2011.10.009

[8] Laughlin S, Baird D, Savitz D, et al. Prevalence of Uterine Leiomyomas in the First Trimester of Pregnancy: An Ultrasound Screening Study. Obstetrics and Gynecology. 2009 March;113(3): 630-635. URL: https://doi.org/10.1097/AOG.0b013e318197bbaf

[9] Vergani P, Locatelli A, Ghidini A, Andreani M, Sala F, Pezzullo JC. Large uterine leiomyomata and risk of cesarean delivery. Obstet Gynecol. 2007 Feb;109(2 Pt 1):410-4. URL: https://doi.org/10.1097/01.AOG.0000250470.78700.f0

[10] Michels KA, Velez Edwards DR, Baird DD, Savitz DA, Hartmann KE. Uterine leiomyomata and cesarean birth risk: a prospective cohort with standardized imaging. Ann Epidemiol. 2014 Feb;24(2):122-6. URL: https://doi.org/10.1016/j.annepidem.2013.10.017

[11] Zhao R, Wang X, Zou L, Li G, Chen Y, Li C, et al. Adverse obstetric outcomes in pregnant women with uterine fibroids in China: A multicenter survey involving 112,403 deliveries. PLOS One. 2017:12(11): e0187821. URL: https://doi.org/10.1371/journal.pone.0187821

[12] Wise Lauren, Laughlin-Tommaso, Shannon k. Epidemiology of Uterine Fibroids, Clinical Obstetrics and Gynecology: March 2016 - Volume 59 - Issue 1 - p 2-24. URL: https://doi.org/10.1097/GRF.0000000000000164

[13] Febo G, Tessarolo M, Leo L, et al. Surgical management of leiomyomata in pregnancy. Clinical and Experimental Obstetrics & Gynecology. 1997;24(2):76-78.

[14] Çelik Ç, Acar A, Çiçek N, Gezginc K, Akyürek C: Can Myomectomy Be Performed during Pregnancy? Gynecol Obstet Invest 2002;53:79-83. URL: https://doi.org/10.1159/000052997

[15] Morgan OF, Piña RB, Elorriaga GE, et al. Uterine leiomyomas during pregnancy and its impact on obstetric outcome. Ginecol Obstet Mex. 2011;79(08):467-473.

×