[Clinical analysis of 12 cases of pregnancy complicated with diffuse uterine leiomyomatosis].

Objective: To analyze the clinical characteristics, diagnosis and treatment of pregnancy complicated with diffuse uterine leiomyomatosis (DUL), and to explore the treatment strategies for its complications during pregnancy and perinatal period. Methods: The clinical data of 12 pregnant women with DUL who delivered in Peking University Third Hospital from May 2017 to October 2024 were collected, and their complications during pregnancy and perinatal period, radiological features, and treatment strategies were analyzed. Results: The median age of 12 pregnant women with DUL was 32 years (range: 28 to 38 years), and all of them were primiparas with singleton pregnancy. Among the 12 pregnant women, only 7 cases (7/12) were suspected of DUL by imaging examination during pregnancy. Five cases (5/12) only showed multiple uterine fibroids by ultrasound and magnetic resonance imaging during pregnancy, which were finally diagnosed according to intraoperative exploration. Five cases (5/12) of DUL had signs of threatened abortion or threatened preterm birth such as uterine contraction and bleeding during pregnancy, including 3 cases of preterm birth (2 cases of spontaneous preterm birth and 1 case of iatrogenic preterm birth due to prenatal hemorrhage). Among the 12 pregnant women with DUL, 2 cases (2/12) had abnormal fetal position, 3 cases (3/12) had placental adhesion, and 1 case (1/12) had fibroid degeneration. Among the 12 pregnant women with DUL, 9 cases (9/12) were delivered by cesarean section, of which 3 cases were converted to cesarean section because of failed trial of labor, and 6 cases were directly terminated by cesarean section because of abnormal fetal position or previous myomectomy history. Postpartum hemorrhage occurred in 5 cases (5/12), including 4 cases of severe postpartum hemorrhage, and uterine tamponade had good hemostatic effect. Three cases (3/12) had fever after operation or postpartum. All the 12 pregnant women were discharged in a stable condition. Among the 12 neonates, 2 (2/12) were transferred to the department of pediatrics due to premature birth and finally discharged smoothly. Conclusions: Pregnancy complicated with DUL is a high-risk pregnancy, which increases the risk of complications during gestation, delivery and postpartum. Uterine cavity compression hemostasis may be an effective measure to deal with postpartum hemorrhage.