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Recurrent Miscarriage and Fibroids
Recurrent miscarriage — also known as recurrent pregnancy loss and habitual abortion — is defined as the loss of three or more pregnancies in a row at less than 24 weeks gestation. While there are many reasons a woman may experience recurrent miscarriage, British researchers have recently found that one thing that can improve the pregnancy outcome is to remove fibroids that distort the shape of a woman's uterus.
The Link Between Fibroids and Miscarriage
The British researchers examined retrospective and prospective data from a large tertiary referral recurrent miscarriage clinic to determine if fibroids were causing the repeated miscarriages and whether removing the fibroids would lead to improved outcomes. They included 25 women with cavity-distorting fibroids who had surgery, and 54 women with fibroids that didn't distort the cavity and who did not undergo any intervention. These patients were compared with a control group of 285 women with unexplained recurrent miscarriage. The patient demographics across the groups were similar; however, on average, the patients with fibroids were slightly older than the women with unexplained recurrent miscarriage. Fibroids were diagnosed using combined transvaginal ultrasound and hysterosalpingography.
The study, led by Sotirios H. Saravelos of the University of Sheffield in the U.K., found that women with fibroids distorting the uterine cavity had a total miscarriage rate of 76.7 percent and a live birth rate of 23.3 percent. Women with cavity-distoring fibroids also had a higher mid-trimester miscarriage rate (21.7 percent) than the group of women with unexplained recurrent miscarriages (8 percent).
They researchers found that women who had cavity-distorting fibroids and underwent surgery to remove them with a hysteroscopic myomectomy had significantly improved outcomes, with a significant drop in the mid-trimester miscarriage rate and a live birth rate increasing from 23.3 percent to 52 percent. The study was published in the journal Human Reproductive.
The researchers concluded that women with a previous history of mid-trimester loss should have a thorough exam for fibroids. In addition, myomectomy should be performed on those with fibroids that distort the uterine cavity in order to improve live birth rates. They wrote in the study's conclusion: "Fibroids are associated with increased mid-trimester losses amongst women with [recurrent miscarriage]. Resection of fibroids distorting the uterine cavity can eliminate the mid-trimester losses and double the live birth rate in subsequent pregnancies."
What are Cavity-Distorting Fibroids?
Fibroid tumors are usually non-cancerous masses that grow in the uterus, of which there are three primary types that are classified according to location: subserosal, intramural, and submucosal.
Submucosal fibroids are the least common type of fibroid and develop just under the lining of the uterine cavity. These are the fibroids that distort the uterine cavity.
What is a Hysteroscopic Myomectomy?
Hysteroscopy is an outpatient procedure in which the fertility doctor uses a narrow fiber optic telescope inserted into the uterus through the cervix to look for adhesions inside the uterus. With a hysteroscopic myomectomy, the fertility doctor uses a resectoscope — a hysteroscope fitted with a wire loop that uses high-frequency electrical current to cut tissue.