Uterine fibroid characteristics and complications in early pregnancy ultrasound scan; a retrospective analytical study at RAAJ Specialist Scan in Southern Ghana

doi:10.21203/rs.3.rs-1648413/v1

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Uterine fibroid characteristics and complications in early pregnancy ultrasound scan; a retrospective analytical study at RAAJ Specialist Scan in Southern Ghana

https://doi.org/10.21203/rs.3.rs-1648413/v1

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This study assessed the correlation between uterine fibroid characteristics and the complications of early pregnancy using ultrasound scan. A retrospective cross-sectional study was conducted among 174 women within 10weeks of gestation from November 2020 to October 2021 at a single specialist facility in Cape Coast metropolis. Patients’ age, indications, gestational age, fetal heart rate, presence of fibroids, presence of placenta, characteristics of the fibroids (size, number, location and echopattern), and early pregnancy complications. Data were summarized with descriptive statistics, Fisher exact was used to compare proportions and Pearson correlation tests to assess associations at p < 0.05. The prevalence of fibroid in early pregnancy was 31.61%. The majority of the fibroids (63.64%, 35) were intramural, located in the upper segment and often multiple but the mean size of the largest fibroids was 5.63 (SD 3.16) cm. The incidence of fetal death was higher among women without fibroids (3.36%) compared to those with fibroid (1.82%). Threatened miscarriages (2.30%), and missed abortion (2.30%) were commonest ultrasound abnormalities. There was no significant correlation between fibroid characteristics and early pregnancy complications. Ultrasound investigation of uterine fibroid is essential in early pregnancy to target treatment intervention for better fetal and maternal health outcomes.

Early pregnancy

Ultrasound scan

Uterine fibroids

miscarriage

menorrhagia

Uterine fibroids are benign tumours whose growth are associated with progesterone and estrogen[1] hence rapid growth is expected in pregnancy. Uterine fibroid has become a major burden in women, with a major risk factor being black women[2]. Current estimate shows prevalence rate of more than 80% among African-American women by the age of 50 compared to 70% in Caucasian women and approximately 40–60% in reproductive age group[1]. The prevalence of uterine fibroids in Accra, Ghana is reported as 36.9% [3] compared to 12.1% in Northern Nigeria[4]. Hitherto believed to be inert, literature abound to the effect of fibroids on endometrial function which may affect the fertility wishes of women[5]s. Fibroids may also present as excessive menstrual bleeding, pressure symptoms such as pelvic pain, frequent urination or constipation[1]. Studies have associated fibroids to submucosal, intramural or subserosal. Submucosal myomas may distort the endometrium and affect implantation or displaced and compress gestational sac leading to miscarriage[6–9]. The echogenicity of fibroids may be hypoechoic, hyperechoic, isoechoic or commonly mixed echogenicity[3].

Fibroids are likely to co-exist with pregnancy because of the prevalence of fibroids in the reproductive age[6, 7, 10–12]. The incidence of uterine fibroid increases with increasing age. High prevalence of fibroids in older women > 35years have been reported in Ghana [13] and Nigeria[14]. The fibroids may present with pressure symptoms such as frequent urination, lower abdominal pain or bleeding. The aforementioned symptoms are frequently seen in early pregnancy. There is little information on the characteristics of uterine fibroids and its effects in early pregnancy.

Early pregnancy in this study is defined as pregnancy which can be visualized by ultrasound scan using either the gestational sac or crown rump length (from 5weeks up to 14weeks). Ultrasound scan is the modality of choice in the investigation of uterine fibroids at all stages of pregnancy because it is safe and does not involve radiation. Common complications of early pregnancy include ectopic pregnancy, molar pregnancy and miscarriage (threatened, incomplete, inevitable, complete)[15]. The most common complication of uterine fibroid is menorrhagia which can lead to severe anaemia.

The rationale for the study stems from the fact that uterine fibroids are common in women of reproductive age, thus common in pregnancy. A pilot study conducted at RAAJ Specialist Scan for the months of January and February 2020 showed a prevalence of 35.3% of uterine fibroids in early pregnancy. Early pregnancy complications such as bleeding, lower abdominal pain and early pregnancy loss may mimic symptomatic uterine fibroids. There is a gap in the literature in Ghana on the correlation between uterine fibroids and early pregnancy complications, which is the primary focus of this study. It is noted that diagnosis of uterine fibroids in early pregnancy will help with follow up plans.

This examined the correlation between uterine fibroid characteristics (size, location, number and echopattern) and the complications of early pregnancy using ultrasound scan at RAAJ Specialist Scan. Specifically, the study sought to determine/assess the following:

the prevalence of uterine fibroids in early pregnancy using ultrasound scan at RAAJ Specialist Scan over 12months period.

the characteristics of uterine fibroids (size, location, number and echopattern) in early pregnancy using ultrasound scan at RAAJ Specialist Scan

the correlation between characteristics of uterine fibroid (such as size, location, number, and echopattern of uterine fibroids) and presence of early pregnancy complication.

Study Design and population

This is a retrospective cross-sectional study conducted at RAAJ Specialist Scan. It is a private diagnostic centre based in Cape Coast and Takoradi with an estimated study population of 1692 patients per year. The study included records of all women with early pregnancy (5-14weeks gestation) who presented to the centre for pelvic ultrasound scan between 1st November 2020 and 31st October 2021.

Sample size

Using the Cochrane formula n₀ = Z²pq/e², where: e is the desired level of precision (i.e. the margin of error), p is the (estimated) proportion of the population which has the attribute in question, q is 1 – p, and Z (critical value at 5% significance level) = 1.96. Previous study in Nigeria reported a proportion of 12.3% of pregnancies co-existing with fibroids[16]. Hence, p = 12.3%, e- 0.05, q – 1-0.123 = 0.877, final minimum sample size calculated is 166 patients. All patients who meet the inclusion criteria were included in the study.

Inclusion and Exclusion criteria

The study involved ultrasound reports of women with early pregnancy who presented to the centre for pelvic ultrasound scan between November 2020 and October 2021. Early pregnancy, as defined as pregnancy from 5-14weeks gestation. Pregnancy above 14weeks or below 5weeks.

Data collection

Information retrieval checklist was used to capture information of all women with early pregnancy who presented at the centre for pelvic ultrasound scan within the study period. Variables of interest included age of women, gestation age, indications for the scan, presence of fibroid, characteristics of fibroid in terms of location (pedunculated, subserosal, intramural or submucosal), size of the fibroid or largest fibroid if multiple, number (counted in numerical terms), and echopattern, mixed, degenerating, calcifications). The information obtained from the ultrasound scan reports were directly entered into Microsoft Excel for data management.

Statistical analysis

The data was exported with STATA 16 for the analysis. Data was summarized with descriptive statistics using mean (Standard deviation), frequencies and percentages. Fisher exact test and Pearson correlation test were used to assess association between fibroid location, number, size, echopattern and early pregnancy complications at p value < 0.05.

Demographic characteristics of women

The age distribution of women with fibroid status shown in Table 1. The average age of the participants was 30.72 ± 4.85 years. The majority (58.62%, 102) were between the ages of 30 and 39years. The women with fibroid were relatively older (31.98 ± 4.36years) than those without fibroid (30.13 ± 4.97) (p = 0.041) (Table 1).

Table 1

Age distribution of participants by fibroid status
Age	Fibroid N = 55(%)	No fibroid N = 119(%)	Total N = 174(%)
Mean(SD)	31.98 ± 4.36	30.13 ± 4.97	30.72 ± 4.85
>30 years	14 (25.45)	51 (42.86)	65 (37.36)
30–39 years	37 (67.27)	65 (54.62)	102 (58.62)
≥40years	4 (7.27)	3 (2.52)	7 (4.02)
SD-standard deviation

Prevalence of uterine fibroids in early pregnancy

The study examined 174 pregnant women who whose gestation were less than 14 weeks. Fibroid was detected in 55 (31.61%) of the women who were pregnant (Fig. 1).

Characteristics of uterine fibroids as defined by ultrasound

As shown in Table 2, majority (63.64%, 35) of the fibroid were intramural fibroids, located at the upper segment (52, 94.55%), 33 (60.00%) of the women had three or more fibroids with the average diameter of the largest fibroid measuring 5.63 (± 3.16) cm. Fibroids of small (< 5cm) and medium (5-10cm) sizes were found in 30 (54.55%) and 20 (36.36%) of the women, respectively. Only seven fibroids had echopattern documented, and all seven fibroids (12.73%) were heterogeneous. Similarly, only four (7.27%) and eight (14.55%) fibroids had degeneration and calcifications documented respectively (Table 2).

Table 2

Clinical features of uterine fibroids among patients with fibroids
Features	No. of patients(n = 55)	Percentage (%)
Types of uterine fibroids
Intramural	35	63.64
Sub-serosal	15	27.27
Sub-serosal	4	7.27
Pedunculated	1	1.82
Location of uterine fibroids
Lower segment	2	3.64
Upper segment	52	94.55
Mixed segments	1	1.82
Number of fibroid
1	13	23.64
2	9	16.36
3 or more	33	60
Size of Largest fibroid
Mean(SD)	5.631 ± 3.16
Category
Small (< 5cm)	30	54.55
Medium (5-10cm)	20	36.36
Large (> 10cm)	5	9.09
Echopattern of uterine fibroids
Heterogeneous	7	12.73
Not stated	48	87.27
Degeneration
Present	4	7.27
Absent	51	92.73
Calcifications
Present	8	14.55
Absent	47	85.45
SD- standard deviation

Table 3 shows the distribution of clinical features of uterine fibroid by maternal age. The majority of the fibroids were intramural (63.64%, 35) and were found to be more common in two age categories (30–39 years (75.68%, 28) and 40 years plus (75.00%, 3). On the other hand, sub-serosal fibroids were more common in patients under the age of 30 years (42.86%, 6). Patients under 30 years (64.29%) and 30–39 years old (54.05%) had the highest number of small fibroids (< 5 cm). Only patients aged 30–39 years were found to have large (> 10cm) fibroids (5, 13.51%). Fibroid associated to the upper segments was highest across all age groups. Similarly, patients who had three or more fibroids were highest in all the three age groups. The distribution of types fibroid varied significantly across the age groups (p = 0.004). However, there was no significant difference between the maternal age groups and fibroid size (p = 0.351), fibroid locations (p = 0.263), and number of fibroids (p = 0.321) (Table 3).

Table 3

Distribution of fibroid location and maternal age of patients
Clinical features	Maternal age, n(%)			Fisher test
Clinical features	> 30 years (N = 14)	30–39 years (N = 37 )	≥ 40years (N = 4)	Fisher test
Types				p = 0.004
Sub-mucosal	4 (28.57)	0 (0.00)	0 (0.00)
Intramural	4 (28.57)	28 (75.68)	3 (75.00)
Sub-serosal	6 (42.86)	8 (21.62)	1 (25.00)
Pedunculated	0 (0.00)	1 (2.70)	0 (0.00)
Fibroid size				p = 0.351
Small (< 5cm)	9 (64.29)	20 (54.05)	1 (25.00)
Medium (5-10cm)	5 (35.71)	12 (32.43)	3 (75.00)
Large (> 10cm)	0 (0.00)	5 (13.51)	0 (0.00)
Segmental Location				p = 0.263
Lower segment	0 (0.00)	1 (2.70)	1 (25.00)
Upper segment	14 (100.00)	35 (94.59)	3 (75.00)
Mixed segments	0 (0.00)	1 (2.70)	0 (0.00)
Number of fibroid				p = 0.321
1	4 (28.57)	9 (24.32)	0 (0.00)
2	4 (28.57)	4 (10.81)	1 (25.00)
3 or more	6 (42.86)	24 (64.86)	3 (75.00)

Clinical characteristics of pregnancy with and without uterine fibroids

The overall mean gestational age at diagnoses was 8.99 (SD = 2.70) weeks. Majority (138, 79.31%) of pregnant women with fibroids were within the first trimester (0–12 weeks). Fetal demise was seen in five (2.89%) of 174 pregnancies examined. The incidence of fetal deaths was higher in women without fibroid (3.36%) compared to those with fibroid (1.82%). The mean fetal heart rate (FHR) was 142.76 ± 37.93 bpm, with normal FHR noted in 67.24% fetuses (110–160 bpm). Only 10 (5.75%) out of the expected 68 pregnancies had placenta stated. Placenta relations with fibroids was reported in 14 pregnancies, two (3.64%) and 12 (21.82%) of fibroids were respectively in retroplacental and superior position to the placenta. None of clinical features of fetus was significant associated with the presence of uterine fibroid (Table 4).

Table 4

Clinical features of fetus among patients studied
Features	Total N = 174(%)	Fibroid N = 55(%)	No fibroid N = 119(%)	Exact test
Gestational age (weeks)				P = 0.203
Mean (SD)	9.31 ± 2.81	9.93 ± 2.91	9.03 ± 2.72
First trimester (0–12)	138 (79.31)	40 (72.73)	72 (88.89)
Second trimester (13–14)	35 (20.11)	15 (27.27)	9 (11.11)
Not stated	1 (0.57)	0 (0.00)	1 (0.84)
Fetal outcome				P = 0.494
Alive	169 (97.13)	54 (98.18)	115 (96.64)
Died	5 (2.87)	1 (1.82)	4 (3.36)
Fetus heart rate				P = 0.613
Mean(SD)	142.76 ± 37.93	149.90 ± 25.55	139.45 ± 42.15
110–160 bpm	177 (67.24)	39 (70.91)	78 (65.55)
>160bpm	47 (277.01)	15 (27.27)	32 (26.89)
Not stated	5 (2.87)	0 (0.00)	5 (4.20)
Not applicable#	5 (2.87)	1 (1.82)	4 (3.36)
Placenta formed				P = 0.429
Yes	10 (5.75)	5 (9.09)	5 (4.20)
No	164 (94.25)	50 (90.91)	114 (95.80)
Placenta location (n = 10)				P = 1.000
Upper Anterior	7 (70.00)	4 (80.00)	3 (60.00)
Low-lying Posterior	1 (10.00)	0 (0.00)	1 (20.00)
Upper Posterior	2 (20.00)	1 (20.00)	1 (20.00)
Placenta relations with fibroids				NA
Retroplacental	2 (3.64)	2 (3.64)	0 (0.00)
Superior to the placenta	12 (21.82)	12 (21.82)	0 (0.00)
Not stated	41 (74.55)	41 (74.55)	0 (0.00)
# Not alive during the scan; SD- standard deviation; NA-not applicable

Association between presence of uterine fibroids and early pregnancy complications

The association between fibroids status, indications as stated on the request form and ultrasound diagnosis in early pregnancy has been shown in Table 5. Cyesis was the commonest indication mostly among patients without fibroid (74.79%, 89), however, bleeding during pregnancy was associated with fibroid (p < 0.001). Common ultrasound abnormalities identified included inevitable abortion (2, 1.5%), threatened pregnancies (4, 2.30%), missed abortion (4, 2.30%) as well as cervical dilatation (2, 1.15%). However, majority of these patients did not have uterine fibroids (p = 0.656) (Table 5).

Table 5

Association between fibroids indications and ultrasound impression in early pregnancy
Complications	Total N = 174(%)	Fibroid N = 55(%)	No fibroid N = 119(%)	Exact test
Indications				P < 0.001
Missed/threatened abortion	4 (2.30)	1 (1.82)	3 (2.52)
Cyesis/pregnancy	114 (65.52)	25 (45.45)	89 (74.79)
Bleeding	28 (16.09)	11 (20.00)	17 (14.29)
Lower abdominal pain	5 (2.87)	1 (1.82)	4 (3.36)
Recurrent miscarriage	3 (1.72)	1 (1.82)	2 (1.68)
Other^&	3 (1.72)	1 (1.82)	2 (1.68)
Not stated	17 (9.77)	15 (27.27)	2 (1.68)
Ultrasound diagnosis				P = 0.075
Normal Cyesis/pregnancy	159 (91.38)	50 (90.91)	109 (91.60)
Inevitable abortion	2 (1.15)	0 (0.00)	2 (1.68)
Threatened abortion	4 (2.30)	0 (0.00)	4 (3.36)
Missed abortion	4 (2.30)	1 (1.82)	3 (2.52)
Cervical dilatation	2 (1.15)	1 (1.82)	1 (0.84)
Other^#	3 (1.72)	3 (5.45)	0 (0.00)
&-other indications included reduced liquor volume (1), amenorrhoea (1) and cervical incompetence (2); #-other impression short cervical length, cervical funneling, and fetal bradycardia

Correlation between characteristics of uterine fibroid and ultrasound early pregnancy complication

As shown in Table 6, there was no significant correlation between characteristics of uterine fibroids (size(r=-0.0128, p = 0.9259), location(r = 0.0247, p = 0.8580), number(r=-0.0617, p = 0.6547), and echopattern(r = 0.1208, p = 0.3798).) and the early pregnancy complications (Table 6).

Table 6

The correlation between the uterine fibroid characteristics and ultrasound findings in early pregnancy
Uterine fibroid characteristics	Early pregnancy complications- Pearson correlation test
Uterine fibroid characteristics	Coefficient (r)	p-value
Size of uterine fibroids	0.0128	0.9259
Location of uterine fibroids	0.0247	0.8580
Number of uterine fibroids	-0.0617	0.6547
Echopattern of uterine fibroids	0.1208	0.3798

Uterine fibroids (also known as myomas) are by far the most common pelvic tumors in women of reproductive age[17]. They are benign monoclonal smooth muscle neoplasms[17]. It may cause pregnancy loss, but the link between uterine fibroids, recurrent miscarriages, and other pregnancy related complications in women is not well understood[8, 11, 12, 17]. The impact of fibroid may depend on the size and location[6, 12, 17]. It may change the shape of the intrauterine cavity, resulting in decidual atrophy or distortion of the decidua vascular architecture, affecting implantation, placentation, and the pregnancy's continuation[6, 17, 18]. Limited evidence has hampered ongoing efforts in underdeveloped nations like Ghana to address the prevalence of pregnancies and their influence on coexistence[3]. This study adopted a retrospective cross-sectional study to assess the correlation between uterine fibroid characteristics and complications in early pregnancy at RAAJ Specialist Scan.

The mean aged of pregnant women in this study was 30.72 ± 4.85years. This was comparable to the findings of Sarkodie et al.[3] who reported a mean age of 31.89 ± 7.92 years in a Ghanaian population. This finding also corroborates with another study in Cameroon which found that the majority of pregnant women were between the ages of 25 and 35[6]. Aging has been strongly linked with occurrence of fibroid[3, 6, 17]. This assertion was observed in this study, where women diagnosed of fibroid were significantly older (32.00 ± 4.47 years) than those without fibroid (30.10 ± 5.11 years). Similarly, Egbe et al.[6] also found that women with uterine fibroids in pregnancy were older than those without fibroid. On the other hand, Sarkodie et al.[3] found the highest prevalence (42.2%) of the fibroid cases among women aged < 35 years and the lowest (17.8%) recorded among women aged greater than 45 years. The difference in aged pattern between this two studies could be attributed to the type of sample investigated, accuracy of tools used and personnel involved.

The co-existence of uterine fibroids and pregnancy has been previously reported in few African studies[3, 6, 7, 19]. We reported fibroid prevalence of 31.61% among 174 pregnancy women in Cape Coast. This value is comparable to the 36.9% reported by Sarkodie et al.[3] among 244 women of childbearing age evaluated in Ghana. In a similar research of 288 pregnant women in Cameroon, the rate was twice as low (16.7%)[6]. On the contrary, a multi-center, retrospective cross-sectional survey of women in China reported a prevalence 2.63% among 112,403 women[8]. The disproportionate prevalence of fibroid in black women compared to white women has been linked to the high amounts of oestrogen receptors ER-α PP genotype present in black women[6, 20]. Also, the disparities in prevalence rates reported from these settings could be linked to the socioeconomic differences, the level of implementations of maternal and child health policy especially on early detection and treatment of maternal conditions. The relatively lower prevalence from China demonstrates that Chinese women are well protected against fibroids compared to counterparts in developing countries like Ghana and Cameroon.

The clinical presentation of uterine fibroids depends on the location of the fibroids which may be intramural, subserosal, pedunculated, submucosa or mixed[3, 6, 8, 16, 20–22]. Intramural fibroid was the predominant type identified in the current study, contributing 63.64% of all the fibroids detected. However, different patterns have been reported by previous studies. Zhao et al.[8], Cagan et al.[17], Eze et al.[19] and Egbe et al.[6] found subserosal fibroid as the most common type seen in China, Turkey, Nigeria and Cameroon respectively. Although various biological mechanisms such as genetics, microRNA, steroids, growth factors, cytokines, chemokines, and extracellular matrix components have been implicated in the development and growth of fibroids,[12, 18, 20] the disparity in fibroid locations are less studied.

Multiple fibroids were found to be much higher among women in their early pregnancy, according to the findings of this study. In this study, two-thirds of the women diagnosed with fibroid had three or more fibroids and the incident increased with age. Consistent with this finding, Eze et al.[19] found that majority of myomas co-existing with pregnancy were multiple[19]. This is contrary to previous study in China which reported a large proportion of women with single fibroid[8]. This disparity could be linked to the high levels of oestrogen receptors ER-α PP genotype in blacks compared to caucasians[6, 20]. It is also worth noting that women who have had previous fibroid surgery are less likely to be identified with numerous fibroids, a prevalent practice in Western countries like China.

The average size of fibroids in this study (5.01 ± 3.14 cm) was greater than in other studies. For instance, 2.82 ± 1.64cm reported in Cameroon by Egbe et al.[6], 3.2 ± 0.9 cm in Italy by De Vivo et al.[22] 2.16 ± 0.75cm in Turkey by Cagan et al.[17] were relatively lower compared to the current study. Although the causes of this discrepancy is unknown, disparities in socioeconomic background linked with these countries may have influenced women's reported sizes. The study samples had a variety of maternal characteristics, including but not limited to maternal age, gestational age status, parity, and so on. The majority of the women had tiny (5cm) fibroids, and the prevalence dropped as the size of the fibroids increased. This is inconsistent with findings by De Vivo et al.[22] who found a significant increase in fibroid size in a high percentage of pregnant women. On the other hand, Sarkodie et al.[3] found an evenly distributed sizes of fibroid nodules in their study population.

A number of studies have reported miscarriage, fetal death, vaginal bleeding, preterm delivery, acute abdominal and pelvic pain, placenta previa and several others as complications associated with uterine fibroids among pregnant women[6, 8, 19]. These are consistent with complications reported in this study. Vaginal bleeding was a predominant complication seen among the patients examined and this was significantly higher in patients with fibroid than those without fibroid. Similarly, Egbe et al.[6] found vaginal bleeding to be a significant complication among pregnant women with fibroid co-existence in Cameroon. Despite the report of multiple fibroids among the women, there was no significant correlation between uterine fibroids and early pregnancy complications reported in this study. On the contrary, previous study linked presence of fibroid with acute abdominal pain and vaginal bleeding[6]. An explanation for the lack of correlation found in this study could be due to the fact that a considerable number of pregnant women assessed had a small fibroid size, which fell below the threshold for an elevated risk of unfavorable obstetric outcomes[21]. Furthermore, it should be highlighted that the genesis of obstetric complications is a multifaceted process that is not solely attributed to the existence of uterine fibroids in women.

Limitation of the study

This study emphasizes the necessity of fibroids studies and supporting data on the local prevalence of fibroids in pregnancy. The strength of the study is that, large amount of data is generated and the patients are unselected, however, there was a significant amount of missing data, and unable to draw any definitive conclusions on the correlation of maternal fibroids and fetal outcomes. For example, only seven out of 55 patients diagnosed with fibroids had an echopattern captured in the reports. A prospective study will help cure this limitation.

In order to target treatment intervention in pregnant women for better fetal and maternal health outcomes, ultrasound investigation of uterine fibroid in early pregnancy is crucial to guide treatment intervention in pregnant women. Uterine fibroid co-existence with early pregnancy was shown to be prevalent in 31.61% of the ultrasound reports reviewed in this study. Women who had uterine fibroids were on average older than women who did not have fibroid tumors. Intramural fibroids were the most common form of fibroids found in the women studied. The vast majority of the fibroids were found in the upper anterior portion of the uterus. The most common early pregnancy complications observed in this study were bleeding, lower abdominal pain, missed abortion, cervical dilatation, inevitable abortion, threatened pregnancy, and fetal deaths. None, on the other hand, was found to be significantly associated with uterine fibroids in early pregnancy.

We recommend scheduling follow-up scans to determine if the size of the uterine fibroids changes as the pregnancy proceeds and the rate of increase. A more representative study should be undertaking and if the results are similar, in-service training should be organized to increase the knowledge of the sonographic patterns of uterine fibroids among sonographers in Ghana in order to improve the quality of diagnosis and documentations. Future research should focus on the maternal profile of previous pregnancy complications, as this may influence the present pregnancy's outcome.

FHR

Fetal Heart Rate

CCTH

Cape Coast Teaching Hospital

ERC

Ethical Review Committee

Ethics approval and consent to participate

The study protocol was approved by the Cape Coast Teaching Hospital Ethical Review Committee (ERC)(Ref: CCTHERC/EC/2021/121). Although CCTHERC waived the requirement of the informed consent for this study, informed consent was obtained from all subjects and/or their legal guardian(s) before procedure was performed. All methods were carried out in accordance with relevant guidelines and regulations (declaration of Helsinki). We observed data confidentiality and security by using unique ID numbers instead of patient names and a password protected laptop respectively.

Consent for publication

“Not applicable”

Availability of data and materials

All data generated or analyzed during this study are included in this published article and its supplementary information files (Fibroid dataset).

Competing interests

The authors declare that they have no competing interests

Funding

Self-funded

Authors’ contributions

BBJ: Conceptualization, methodology, resources, investigation, data collection, visualization, drafting, reviewing and editing. BSO and EKA: Supervision, methodology, reviewing and editing. EAI, DA and EB: Data collection, writing- reviewing and editing. All the authors have read and agreed to the final manuscript.

Acknowledgments

Authors are grateful to the Sonographers at the RAAJ Specialist Scan for their assistance. We acknowledge all the clients and patients who visited the RAAJ Specialist Scan and contributed to this study.

Author Information

Affiliations

University of Cape Coast, School of Medical Science, Department of Medical Imaging, Cape Coast, Ghana

Bashiru Babatunde Jimah

University of Ghana School of Medical and Dental Science. Department of Radiology, Accra, Ghana

Benjamin Sarkodie Offei, Edmund Brakohiapa

University of Cape Coast, School of Medical Science, Department of Obstetrics and Gynecology, Cape Coast, Ghana

Evans Kofi Agbeno

37 Military Hospital, Department of Radiology, Accra, Ghana

Ewurama Andam Idun

Korle Bu teaching hospital, Department of Radiology, Accra, Ghana

Dorothea Anim

Zimmermann A, Bernuit D, Gerlinger C, Schaefers M, Geppert K. Prevalence, symptoms and management of uterine fibroids : an international internet-based survey of 21, 746 women. BMC Womens Health. 2012;12(1):6.
Stewart EA, Cookson CL, Gandolfo RA S-RR. Epidemiology of uterine fibroids: a systematic review. Int J Obstet Gyneacology. 2017;124:1501–12.
Sarkodie BD, Botwe BO, Ofori EK. Uterine fibroid characteristics and sonographic pattern among Ghanaian females undergoing pelvic ultrasound scan: a study at 3-major centres. BMC Womens Health. 2016;14–9.
Yusuf Lawal, Ishaku Bala Yaro, Ayyuba Rabiu RE. Prevalence and sonographic patterns of uterine fibroids in Northern Nigeria. New Niger J Clin Res. 2019;8(13):24–9.
Ikhena DE, Bulun SE. Literature Review on the Role of Uterine Fibroids in Endometrial Function. 2018;25(5):635–43.
Egbe TO, Badjang TG, Tchounzou R, Egbe EN, Ngowe MN. Uterine fibroids in pregnancy: Prevalence, clinical presentation, associated factors and outcomes at the Limbe and Buea Regional Hospitals, Cameroon: A cross-sectional study. BMC Res Notes [Internet]. 2018;11(1):4–9. Available from: https://doi.org/10.1186/s13104-018-4007-0
Aymen FM, Amine HM, Ali M, Kais A, Raja A, Slim K, et al. Submucosal myomas and fertility in Tunisian population. PAMJ Clin Med. 2020;3(185).
Zhao R, Wang X, Zou L, Li G, Chen Y, Li C, et al. Adverse obstetric outcomes in pregnant women with uterine fibroids in China: A multicenter survey involving 112,403 deliveries. PLoS One. 2017;12(11):1–11.
Sarkodie BD, Botwe BO, Ofori EK. Uterine fibroid characteristics and sonographic pattern among Ghanaian females undergoing pelvic ultrasound scan: A study at 3-major centres. BMC Womens Health [Internet]. 2016;16(1):14–9. Available from: http://dx.doi.org/10.1186/s12905-016-0288-4
Benaglia L, Cardellicchio L, Filippi F, Paffoni A, Vercellini P, Somigliana E, et al. The rapid growth of fibroids during early pregnancy. PLoS One. 2014;9(1):4–9.
Lisiecki M, Paszkowski M, Wozniak S. Fertility impairment associated with uterine fibroids -A review of literature. Prz Menopauzalny. 2017;16(4):137–40.
Yin FL, Huang HX, Zhang M, Xia XK, Xu H, Liu T, et al. Clinical analysis of uterine torsion and fibroids in full-term pregnancy: A case report and review of the literature. J Int Med Res. 2020;48(6).
Sarkodie BD, Botwe BO, Adjei DN, Ofori E. Factors associated with uterine fibroid in Ghanaian women undergoing pelvic scans with suspected uterine fibroid. Fertil Res Pract. 2016;1–7.
Ukwenya V, Maduemezia N, Afolayan O, Alese O TW. Prevalence of uterine fibroid in a South-Western Nigerian population: A sonographic study. J Exp Clin Anat. 14(1):24–9.
Jackie A KR. Early Pregnancy Diagnosis. StatPearls Publishing 2021 Jan.; 2021. 1–10 p.
Eze CU, Odumeru EA, Ochie K, Nwadike UI, Agwuna KK. Sonographic assessment of pregnancy co-existing with uterine leiomyoma in Owerri, Nigeria. Afr Health Sci. 2013;13(2):453–60.
Cagan M, Tanacan A, Donmez HG, Fadiloglu E, Unal C, Beksac MS. The Effect of Small Size Uterine Fibroids on Pregnancy Outcomes in High-risk Pregnancies. Rev Bras Ginecol e Obstet. 2020;42(9):535–9.
Ciavattini A, Di Giuseppe J, Stortoni P, Montik N, Giannubilo SR, Litta P, et al. Uterine Fibroids: Pathogenesis and Interactions with Endometrium and Endomyometrial Junction. Obstet Gynecol Int. 2013;2013:1–11.
Cu E, Ea O, Ochie K, Ui N, Kk A. Sonographic assessment of pregnancy co-existing with uterine leiomyoma in Owerri, Nigeria. :453–60.
Al–Hendy A, Salama SA. Ethnic distribution of estrogen receptor–α poly– morphism is associated with a higher prevalence of uterine leiomyomas in black Americans. Fertil Steril. 2006;86:686–93.
Delli Carpini G, Verdecchia V, Papiccio M, Grelloni C, Ciavattini A. Comparison of uterine fibroids’ growth pattern during pregnancy according to fetal sex: an observational study. Biol Sex Differ. 2019;10(1):1–7.
De vivo A, Mancuso A, Giacobbe A, Maggio Savasta L, De Dominici R, Dugo N, et al. Uterine myomas during pregnancy: a longitudinal sonographic study. Ultrasound Obs Gynecol. 2011;(37):361–365.
Lev-Toaff AS, Coleman BG, Arger PH, Mintz MC, Arenson RL TM. Leiomyomas in pregnancy: sonographic study. Radiology. 1987;1164(2):375.

No competing interests reported.

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Uterine fibroid characteristics and complications in early pregnancy ultrasound scan; a retrospective analytical study at RAAJ Specialist Scan in Southern Ghana

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Abstract

Figures

Introduction

Methods

Study Design and population

Sample size

Inclusion and Exclusion criteria

Data collection

Statistical analysis

Results

Demographic characteristics of women

Prevalence of uterine fibroids in early pregnancy

Characteristics of uterine fibroids as defined by ultrasound

Clinical characteristics of pregnancy with and without uterine fibroids

Association between presence of uterine fibroids and early pregnancy complications

Correlation between characteristics of uterine fibroid and ultrasound early pregnancy complication

Discussions

Limitation of the study

Conclusions

Abbreviations

Declarations

References

Additional Declarations

Supplementary Files

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