The Association between Uterine Leiomyoma and Postpartum Hemorrhage: A Meta-Analysis

Abstract

Background: Some studies have shown a relationship between uterine fibroids and PPH, while other studies have not shown a risk increase for PPH with uterine fibroids. Objective: The aim of performing the present study was in order to assess the association between uterine leiomyoma and postpartum hemorrhage (PPH) based on epidemiology studies. Methods: We searched for several major international databases (PubMed, Scopus, EBSCO and Web of Science) till Oct 2019. OR was used to measure the association between uterine leiomyoma and postpartum hemorrhage. The combined OR and the corresponding 95 % CI were calculated using random-effects models. In order to control potential confounders, a meta-analysis was carried out based on crude and adjusted form. Homogeneity of effect size was tested by using the Q statistic and to measure the inconsistency across studies and the I2 statistic was used. Funnel plot and the Begg's test was employed to assess possible publication bias. Data were analyzed by the Stata software, version 14, with significance level 0.05. Results: Based on OR estimates obtained from adjusted studies, there was a significant relationship between the uterine leiomyoma and PPH (OR=1.44; 95% CI: 1.14, 1.73). We assessed the association according to statistical adjustment for confounding factors (crude/adjusted) and the association between uterine leiomyoma and PPH in both crude (OR=1.96; 95% CI: 1.03, 2.88) and adjusted (OR=1.23; 95% CI: 1.02, 1.44) report was statistically significant. Conclusion: In this study, uterine leiomyoma was a risk factor for PPH. Therefore, based on our findings in pregnant women with uterine leiomyoma, clinicians should be prepared to manage postpartum hemorrhage after vaginal births and cesarean deliveries.