Obstetric Complications in Women with Uterine Fibroids Admitted for Delivery: A Hospital-Based Cross-Sectional Study

Abstract

Background:Uterine fibroids, or leiomyomas, are the most common benign tumors of the female reproductive tract, affecting 20–70% of women of reproductive age. Their presence during pregnancy can influence labor dynamics, fetal presentation, and postpartum recovery. Large, multiple, or lower-segment fibroids are particularly associated with mechanical obstruction, malpresentation, and postpartum hemorrhage (PPH). While extensive data exist from high-income countries, there is limited prospective evidence from India, where changing reproductive patterns and increased maternal age are contributing to a rising fibroid prevalence. Understanding the relationship between fibroid characteristics and delivery outcomes is essential for optimizing obstetric care in resource-variable settings.

Methods: A hospital-based cross-sectional study was conducted from January to June 2025 in the Department of Obstetrics and Gynaecology, Chettinad Hospital and Research Institute, Tamil Nadu. Fifty term pregnant women (≥37 weeks) with ultrasonographically confirmed fibroids were enrolled. Maternal demographics, fibroid characteristics (number, size, location), and obstetric and neonatal outcomes were recorded. Statistical analysis used Chi-square or Fisher’s exact tests, with p<0.05 considered significant.

Results: Cesarean section was the most common outcome (50%), followed by malpresentation (24%), PPH (16%), and retained placenta (8%). No complications occurred in 30% of participants. Multiple fibroids were significantly associated with cesarean delivery (52% vs. 48%; p=0.032). Fibroids ≥5 cm were linked to higher cesarean rates (60% vs. 40%; p=0.015) and greater PPH incidence (75% vs. 25%; p=0.008). Posterior wall fibroids were most associated with malpresentation (33.3%) and PPH (37.5%) (p=0.045). Mean neonatal birth weight was 2800±450 g; mean Apgar score at 5 minutes was 8.2±1.2. NICU admission occurred in 20% of neonates, mainly for respiratory distress syndrome (50%).

Conclusion: Fibroid size ≥5 cm, multiplicity, and posterior location significantly increase risks for operative delivery, malpresentation, and PPH. Nonetheless, nearly one-third of women delivered without complications. Routine antenatal fibroid assessment and individualized delivery planning are vital for improving outcomes.