Paper Example on Leiomyoma in Pregnancy: Impact of IVF

Introduction

Leiomyomas also called uterine fibroids are non-cancerous in nature and tend to appear in women during their reproductive years. It is important to note that they don't show any relationship with the chances of a person acquiring uterine cancer. They prefer to grow either in single or clusters form. The appearance of leiomyoma through sonographic technique is symmetrical, well-defined, hypoechoic and heterogeneous masses (Wozniak, 2017). FIGO grouped fibroids in terms of its depth within the uterine wall that is type 1 or type 2. For instance, pedunculated is the kind of fibroids that grows on thin muscular stems known as stalks. FIGO classified it as a type 0 fibroid. Fibroids differ in sizes such as some are microscopic, small but detectable and large enough to expand a uterine wall. The most common dimension of leiomyomas is four inches since it allows the stretching of the uterine wall. Several fibroids can stretch the womb lining until it reaches the rib cage. The small and microscopic fibroids don't cause any health effects of a person hence can go unnoticed. The source of uterine fibroids is a stem cell found in the muscular tissue of the womb known as myometrium. Formation of a fibroid involves the division of a single cell multiple times hence creating a leiomyoma. Development of fibroids differ since some grow faster than others or remain in the same dimension. There are types of leiomyomas that shrink or undergo stunted growth. Certain fibroids disappear after delivery because the womb linings go back to its original size. The risk of leiomyomas with pregnancy rose to range from 0.1% to 11 % (Cook,2010). In the USA, statistics estimated that the lifetime risk of uterine leiomyoma development in women is up to 75% (Commandeur, 2015). It is the most common type of tumor which grows and develops in the female reproductive system. It illustrated that there is one in every five women who suffer from fibroids during their childbearing years. The incidence of uterine fibroid increases as women grow older and they may occur in more than 30 percent of women 40 to 60 years of age (Evans, 2007).

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There are factors which influence the spread and development of uterine fibroids. For instance, level of hormones, age, race, genetics and lifestyle disorders such as obesity. Female reproductive hormones in charge of repair and maintenance of the uterine wall include estrogen and progesterone. They encourage the growth of fibroids through stimulation. It illustrates that it is difficult for a woman who reached menopause to acquire fibroids. It is because there is no presence of enough reproductive hormones among old people. Scientists noted that most of the growth of leiomyomas takes place during the first semester of pregnancy. It is because of the high production of estrogen hormones which encourages the growth and development of uterine fibroids.

The incidences reported on gestation period's risks related to leiomyoma range from 5.4 to 77% (Sapric, 2015). Statistics suggested that more than 40% of women within the age group of 35 years have fibroids (Sauer, 2015). The chances of getting the infection increases by the age of 50 to around 80%. From there, the chances of acquiring the medical condition decreases when one reaches infertility. Women can acquire fibroids from their family members since one can transmit through genes. Race is an aspect which has an impact on the development of fibroids. People with African-American origin tend to have a higher risk of getting leiomyoma than the other racial groups. Medical specialists mentioned that black ladies tend to get the medical condition at a tender age and in larger sizes. Experts proved that diseases related to bad lifestyle choices such as obesity play a major role in the development of fibroids. There are habits that one should avoid in case of a fibroid threat such as eating large amounts of red meat, drinking alcohol especially beer, and dairy products. Some people who can contact fibroids started menstruation and birth control at an early age. Doctors encourage individuals to reduce the occurrence of the infection through taking vegetables and fruits. Experts mentioned that bearing a child reduces the risk of acquiring the medical condition. Considering the growing trend of retarding childbearing and the rising rate of obesity, there is a possibility that the incidence of leiomyoma during pregnancy will rise in the future.

Materials and Methods

Study Variables

The total number of variables under study was 37. Researchers conducted the study at the Department of Obstetrics in Xiang Ya Hospital in Central South University in China between1 May 2017 to 31 March 2019. The analysts got informed consent from all recruited patients. Some of the study variables included were maternal age, address, BMI, previous pelvic surgery, smoking, drinking, and number of previous pregnancies, number of spontaneous abortions, pregnancy mode, and number of subserosal leiomyoma, number of submucosal leiomyoma, size of fibroids for different pregnancy periods, location of the fibroid, pregnancy complications, and childbirth complications, amongst others. It is important to note that none of the women smoked or drank alcohol. 66% of the participants had IVF and 61.5% were from the urban regions while the rest were from rural. Participants were eligible since they had at least one uterine fibroid with a mean diameter of 10 cm prior to entering the cycle. The study excluded women carrying more than four myomas.

Methods

The study determined the relationship between pregnant women with leiomyoma who experienced IVF and women with spontaneous pregnancy. Researchers confirmed the presence of leiomyoma through the use of ultrasound examination. The ultrasonography studies focused on fetal anatomy and took place in the prenatal clinic at Xiang Ya hospital. Physicians who conducted the medical examinations used advanced equipment which facilitated increase in precision and accuracy. The conducted analysis showed that from 4,715 females with spontaneous pregnancies only 53 had leiomyoma. Out of 793 people pregnant after IVF, 39 patients had uterine fibroids.

Subjects who got pregnant through both IVF and normal occurrences received various screening tests at the beginning of the study. Researchers conducted ovarian reserve screening to establish the quality and quantity of the eggs. The technique focused on determining the technique the levels of estrogen hormones during the initial days of menstruation. A medical doctor conducted semen analysis and screened for infectious diseases such as HIV before the starting of the IVF cycle treatment. (Wallach, 2004). The study employed an embryo mock transfer test to determine the deepness of the womb cavity. The research used a medical expert to confirm and verify the data on the hospital records. The doctor went ahead to carry out examinations of the womb cavity using techniques such as sonohysterography which entailed the injection of saline fluid into the uterus. The other strategy was hysteroscopy which involved the insertion of a thin telescope through the vagina into the uterus.

All of the subjects who were aware of their uterine fibroids condition. It was mandatory for the research to carry out examinations for clarification. 30% of the subjects used MRI which guides doctors in providing appropriate medication to patients. MRI is a type of screening technique that provides pictorial representations of the fibroids. It indicates the size and location of the infection which helps to determine the type of fibroid (De vivo, 2011). 15% of the subjects employed Hyster sonography which entails the use of sterile saline to increase the size of the womb cavity. It ensures that doctors have an easier time capturing the images of fibroids and endometrium. 20% of the pregnant women got their first diagnosis through hysterosalpingography which is a technique that uses dye to color the specific reproductive parts on X-ray pictures also enables doctors to reveal whether the oviducts are open or not. 5% used hysteroscopy which involves the insertion of an equipment through the cervix therefore injecting saline into the uterine cavity for expansion and easier examination of the uterine walls. Hysteroscope is the tool used during the procedure and it is a lightweight type of telescope directed to reach a person's uterus. It allows medical experts to view a person's reproductive system. There were no cases of laparoscopy because the technique is complex. It involves a technician making a small incision on the skin in the abdominal area then insertion and attachment of a small tube composed of a camera through the abdominal wall layers. The camera has the ability to reach the abdominal and the pelvic cavity thus it is capable of conducting an examination on the outer lining of the uterus and surrounding structures.

The research involved the recruiting of two groups of pregnant women where group A consisted of 39 cases of women with leiomyoma reaching a viable pregnancy because they had an embryo transfer 4-5 weeks ago. On the other hand, group B were 53 women with leiomyoma achieving a viable spontaneous pregnancy. After delivery, both women who employed IVF and those who didn't received an ultrasound examination to determine the location and size of leiomyoma. The research created a strategy to identify suitable subjects for the investigation. The criteria were in two forms which include inclusion and exclusion. It is important to note that the criteria applied to both groups. It facilitated the collection of correlating findings. Inclusion entailed normal gestational period with at least one visible intramural/ subserosal leiomyoma known before the pregnancy. Th...