Pregnancy outcomes in women with large uterine fibroids.

STUDY AIM: To evaluate the effects of the combination of Arabin pessary or cervical cerclage with vaginal micronised progesterone versus micronised progesterone or no medical management on the outcomes of pregnancies in women with large uterine fibroids. MATERIALS AND METHODS: This was a retrospective, observational, controlled study in 120 women aged 18-45 years with large uterine (≥8 cm) fibroids diagnosed in the first trimester, who underwent treatment in the regional perinatal center of the Omsk Regional Clinical Hospital between 2015 and 2019. Women in Group A (n = 90) were divided into two subgroups. In Subgroup А1 (n = 35), participants received the combination of a cervical procedure (Arabin pessary or cerclage) and micronised progesterone, and in Subgroup А2 (n = 55) all participants additionally underwent myomectomy. In Group B (n = 18), only micronised progesterone was used. In Group C (n = 12), no medical therapy was administered during pregnancy. RESULTS: Large uterine fibroids in pregnancy were associated with a threatened pregnancy loss in 46.4% of women and pain in almost 40% of women. Myomectomy in pregnancy was performed in 55 women. The combination of Arabin pessary or cervical cerclage with micronized progesterone reduced the rates of preterm delivery by 2.2-fold versus the progesterone-only group and by 11.2-fold versus no medical management group (χ2 = 19.4; p = .0001). CONCLUSION: The combination of Arabin pessary or cervical cerclage with micronized progesterone in our study helped achieve term deliveries in >90% of pregnant women with large fibroids.

The use of an osmotic dilator for induction of miscarriage in patients with the second trimester missed miscarriage.

AIM: The aim of this study was to assess the outcomes of combined use of dilapan-S and pharmacological induction of miscarriage with mifepristone and misoprostol versus mifepristone and misoprostol only in patients with a second-trimester pregnancy loss. MATERIALS AND METHODS: Our study included 74 patients with a second-trimester antenatal death who were randomized into two groups to receive pharmacological induction of miscarriage combined with intracervical insertion of dilapan-S (n = 37) or pharmacological induction of miscarriage only (n = 37). Efficacy endpoints included: blood loss volume, length of time between the procedure initiation and complete miscarriage, and the number of complications. RESULTS: The use of dilapan-S together with mifepristone and misoprostol for induction of miscarriage in the second trimester in women with antenatal fetal death reduced the time from the start of the procedure to complete miscarriage by 1.98-fold. However, the use of dilapan-S did not significantly reduce the odds of such post-procedural complications as hematometra and retention of the products of conception in the uterus (p = .2501). CONCLUSIONS: Combined management of antenatal pregnancy loss in the second trimester including intracervical insertion of dilapan-S and conventional induction with miscarriage may be considered a valuable clinical strategy. However, future studies should focus on ways to prevent postprocedural complications in this group of women.

Novel combined strategy of obstetric haemorrhage management during caesarean section using intrauterine balloon tamponade.

OBJECTIVE: The aim of this trial was to evaluate the performance of a combined strategy of postpartum haemorrhage management, based upon thromboelastographic (TEG) assessment of coagulation, early surgical haemostasis and mechanical compression of the uterine wall combined with uterine cavity draining, via intrauterine balloon tamponade (BT). METHODS: We carried out an open controlled trial, which included 119 women with obstetric haemorrhage (main group - combined strategy: n = 90, control group - conventional strategy: n = 29). The combined strategy included three essential components: (1) early surgical haemostasis, (2) mechanical pressure upon the uterine wall and draining of the uterine cavity via BT and (3) treatment of blood coagulation disorders identified via TEG. RESULTS: The combined haemorrhage management strategy resulted in significantly lower number of peripartum hysterectomies compared with standard management (4.44% versus 31.03%, respectively, p = 0.02). Blood loss of >2000 ml occurred significantly less common in the main group compared with the control group (16.2% versus 27.6%, respectively, p = 0.03). Mean total blood loss after combined management was significantly lower than after the standard approach (2502 ± 203 ml versus 1836 ± 108 ml, p = 0.04). CONCLUSIONS: The proposed combined strategy of obstetric haemorrhage management represents a powerful tool for fertility-sparing treatment of this life-threatening condition.