Archives of Gynecology and Obstetrics (2018) 297:823–835
Uterine broid size modications during pregnancy and puerperium:
evidence from the rst systematic review of literature
· Marco Noventa
· Attilio Di Spiezio Sardo
· Gabriele Saccone
· Salvatore Gizzo
· Salvatore Giovannni Vitale
· Antonio Simone Laganà
· Giovanni Battista Nardelli
Pietro Salvatore Litta
· Carlo Saccardi
Received: 30 October 2017 / Accepted: 4 December 2017 / Published online: 13 December 2017
© Springer-Verlag GmbH Germany, part of Springer Nature 2017
Purpose The inﬂuence of pregnancy on uterine ﬁbroid size still remains an unsolved dilemma. Basing on current knowledge,
physicians are not able to inform patients about the likelihood of uterine ﬁbroids to modify their size during pregnancy.
Study aim was to summarize available evidence concerning the size modiﬁcations of uterine ﬁbroids during each trimester
of pregnancy and during puerperium.
Methods The review was reported following the PRISMA guidelines and registered in PROSPERO (registration number:
CRD42017071117). A literature search was conducted in electronic database (PubMed, Embase, Sciencedirect, the Cochrane
library and Clinicaltrials.gov) until July 2017. All studies evaluating ﬁbroids’ changes during pregnancy and puerperium by
ultrasound or magnetic-resonance-imaging were included. Descriptive characteristics of studies and patients were collected.
The modiﬁcations of uterine ﬁbroid diameter and volume were the outcome measures.
Results Concerning the ﬁrst trimester of pregnancy, all authors reported a signiﬁcant growth of uterine ﬁbroids. Contradic-
tory evidence was found about uterine ﬁbroid modiﬁcations during the second and third trimesters, mainly supporting a
slowdown during mid pregnancy and a subsequent size reduction during late pregnancy. Concerning the overall modiﬁcations
during pregnancy and puerperium, poor evidence quality suggests that uterine ﬁbroids do not modify their volume/slightly
enlarge during pregnancy and subsequently reduce in size during puerperium.
Conclusions Uterine ﬁbroids seem to be subject to a non-linear trend of modiﬁcations during pregnancy and puerperium,
which may vary from myoma to myoma. Adequate evidence supports uterine ﬁbroid systematic enlargement during the ﬁrst
trimester of pregnancy, while inconsistent evidence is available about the changes of uterine ﬁbroids during second and third
trimesters. In addition, the overall modiﬁcations of myomas during pregnancy and puerperium remain unclear.
Keywords Uterine ﬁbroids · Fibroid size · Size modiﬁcations · Pregnancy · Puerperium
Uterine fibroids (UFs), also known as myomas or leio-
myomas, are benign monoclonal neoplasms of the smooth
muscle layer of uterus [1, 2]; they represent the most com-
mon benign gynecological tumors in young women, with a
prevalence increasing with age from 40 to 60% at 35 years
to 70–80% at 50 years old .
Despite their benign histological features, UFs have con-
siderable economic and social impacts, being the most com-
mon clinical indication to hysterectomy in USA and repre-
senting a possible cause of hospitalization and complications
during pregnancy [2, 4, 5]. As a matter of fact, UFs aﬀect up
to 10.7% of pregnant women and in 10–30% of cases may be
* Amerigo Vitagliano
Unit of Gynecology and Obstetrics, Department of Women
and Children’s Health, University of Padua, Via Giustiniani
3, 35128 Padua, Italy
Department of Public Health, School of Medicine, University
of Naples Federico II, 80131 Naples, Italy
Unit of Gynecology and Obstetrics, Department of Human
Pathology in Adulthood and Childhood ‘‘G. Barresi’’,
University of Messina, 98125 Messina, Italy