Perinatology and pediatric.Ukraine. 2017.4(72):60-66; doi 10.15574/PP.2017.72.60

Aleksenko O. O., Odintsova H. M., Medvediev M. V.
Communal Healthcare Institution "Mechnikov Regional Clinical Hospital", Dnipro, Ukraine
Dnipro Primary Health Care Centre No. 9, Dnipro, Ukraine
SI "Dnipropetrovsk Medical Academy of the MHU", Dnipro, Ukraine

Objective: to study the effect of myomectomy on uterine contractility and the rate of pregnancy in patients with its abnormalities.
Material and methods. A clinical trial was conducted on the basis of Mechnikov Dnipropetrovsk Regional Clinical Hospital during 2013-2016. The patients were divided into three groups: the 1st group comprised 61 women with uterine fibroids, namely intramural or intramural$subserosal locations of the tumor, pre-verified by ultrasound, with infertility of at least 24 months (mean duration infertility was 29±2.2 months); the 2nd (control) group consisted of 36 apparently healthy women without uterine leiomyoma who planned pregnancy; the 3rd group 63 patients with uterine leiomyoma, intramural or intramural-subserosal location of nodes planned pregnancy. In all of them we evaluated the uterine contractility, which was pathological in 80.3%.
Results. The uterine contractility normalized after myomectomy in 20 of 26 women (76.9%). In addition, during the year of observation, 16 (61.5%) women from 20 got pregnant spontaneously. In the 3rd group of women (n=63), there was no infertility since these patients only planned pregnancy, in 27 cases (42.9%) abnormal contractility was detected. During the year of observation, only 5 (18.5%) women managed to get pregnant and only 4 (14.8%) had normal labor and delivery. While in the subgroup of women with leiomyoma n=36 (57.1%) with undisturbed uterine peristalsis pregnancy occurred in 27 (75%) patients. It should be noted that despite the theoretically obvious effect of pathological peristalsis on the probability of spontaneous abortion, our study failed to demonstrate any association of pathological peristalsis with an increase in the incidence of miscarriage. More large-scale studies may be needed to attract more units of observation. Thus, in this study, it has been shown that myomectomy is a method that normalizes impaired uterine peristalsis in more than 50% of cases, and also increases the probability of pregnancy (in 16 (61.5%) of 26 patients) after surgery in women with leiomyoma and impaired peristalsis of the uterus. Taking into account the data obtained from the observation of women with leiomyoma who planned pregnancy and the percentage of unsuccessful attempts to reach the goal, namely (50.8%), it can be concluded that conservative myomectomy is necessary approach in these patients. And vice versa, women who have normal uterine peristalsis and uterine leiomyoma, myomectomy is not necessary, because of its risks.
Conclusions. These data suggest that the presence of uterine leiomyoma causes abnormal peristalsis in some patients, which in turn leads to infertility, and myomectomy can increase the incidence of pregnancy in these patients. Although the importance of intramural fibroids in infertility still leaves room for discussion, the technique of ultrasound examination of the uterine peristalsis provides new possibilities for the selection of patients, who prone to increased success of surgical treatment.
Key words: uterine leiomyoma, uterine contractility, infertility.

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